Organization
GRATIOT DRUG STORE INC
Active
Other names
GRATIOT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ALI NASSER RPH (PRESIDENT)
(313) 999-4748
Entity
Organization
Contact information
Practice address
3745 GRATIOT AVE, DETROIT, MI 48207-1867
(313) 579-2643
(313) 579-2636
Mailing address
3745 GRATIOT AVE, DETROIT, MI 48207-1867
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301008550
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2369191
OTHER ID NUMBER
—
Enumeration date
11/16/2006
Last updated
11/07/2007
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