Organization
KOACH3 INC
Active
Other names
Prestige Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KOMAL ACHARYA (PRESIDENT)
(313) 870-9201
Entity
Organization
Contact information
Practice address
9600 DEXTER AVE, DETROIT, MI 48206-1816
(313) 870-9201
(313) 870-9207
Mailing address
9600 DEXTER AVE, DETROIT, MI 48206-1816
(313) 870-9201
(313) 870-9207
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301009312
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2374039
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/04/2010
Last updated
06/14/2011
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