Organization
AMIGO LLC
Active
Other names
JEFFERSON PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
AHMED SHARAF PHARM. D. (PHARMACIST IN CHARGE/PRESIDENT)
(313) 331-1200
Entity
Organization
Contact information
Practice address
8656 WYOMING ST., DETROIT, MI 48204-5216
(313) 331-1200
(313) 331-1201
Mailing address
8656 WYOMING ST, DETROIT, MI 48204
(313) 331-1200
(313) 331-1201
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301009913
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2137292
PK
—
Enumeration date
10/08/2012
Last updated
08/12/2021
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