Organization
PARK PHARMACY INC
Active
Other names
PARK PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GHADA ABDALLAH RPH (OWNER)
(313) 822-0100
Entity
Organization
Contact information
Practice address
15126 KERCHEVAL AVE, GROSSE POINTE PARK, MI 48230-1360
(313) 822-0100
(313) 822-0101
Mailing address
15126 KERCHEVAL AVE, GROSSE POINTE PARK, MI 48230-1360
(313) 822-0100
(313) 822-0101
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301008498
MI
3336L0003X
Long Term Care Pharmacy
5301008498
MI
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2042400
PK
—
05
—
4998649-87
—
MI
Enumeration date
10/12/2006
Last updated
10/14/2016
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