Organization
UNIVERSAL GRACE PHARMACY LLC
Active
Other names
Universal Grace Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
NOFAL CHOLAG (OWNER, PIC, AO)
(586) 999-5951
Entity
Organization
Contact information
Practice address
31500 DEQUINDRE RD STE 300, WARREN, MI 48092-1057
(586) 999-5951
(586) 999-5956
Mailing address
31500 DEQUINDRE RD STE 300, WARREN, MI 48092-1057
(586) 999-5951
(586) 999-5956
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301010751
MI
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2154721
PK
—
Enumeration date
10/16/2015
Last updated
01/12/2016
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