Organization
SIX MILE PHARMACY LLC
Active
Other names
Six Mile Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
NAZMIEH JADALLAH (OWNER)
(313) 397-7254
Entity
Organization
Contact information
Practice address
7145 W MCNICHOLS RD, DETROIT, MI 48221-2664
(313) 397-7254
(313) 397-7048
Mailing address
7145 W MCNICHOLS RD, DETROIT, MI 48221-2664
(313) 397-7254
(313) 397-7048
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301009401
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2374469
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
2374469
—
MI
Enumeration date
08/13/2010
Last updated
01/30/2013
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