Organization
12 MILE ROAD PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVAN JOHNSON (OWNER)
(248) 677-3584
Entity
Organization
Contact information
Practice address
3348 12 MILE RD, BERKLEY, MI 48072-1344
(248) 677-3584
Mailing address
3348 12 MILE RD, BERKLEY, MI 48072-1344
(248) 677-3584
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
12/05/2019
Last updated
03/18/2021
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