Organization
RAV3 CO
Active
Other names
Glendale Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JANMEYJAY VYAS (PRESIDENT)
(313) 454-4730
Entity
Organization
Contact information
Practice address
211 GLENDALE ST, DETROIT, MI 48203-3231
(313) 454-4730
(313) 454-4735
Mailing address
211 GLENDALE ST, DETROIT, MI 48203-3231
(313) 454-4730
(313) 454-4735
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301009295
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2373809
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/09/2010
Last updated
03/22/2011
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