Organization
WESTSIDE PHARMACY OF DETROIT, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RENARDO GRAY R.PH. (PRESIDENT)
(313) 342-1555
Entity
Organization
Contact information
Practice address
10600 W MCNICHOLS RD, DETROIT, MI 48221-2366
(313) 342-1555
(313) 342-2120
Mailing address
10600 W MCNICHOLS RD, DETROIT, MI 48221-2366
(313) 342-1555
(313) 342-2120
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
004296
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1685936
—
MI
05
—
1978150
—
MI
Enumeration date
08/11/2005
Last updated
03/03/2009
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