Organization
DETROIT MEDICAL PHARMACY INC
Active
Other names
DETROIT MEDICAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMED SOHOUBAH RPH (OWNER PIC)
(313) 831-2400
Entity
Organization
Contact information
Practice address
500 E WARREN AVE, DETROIT, MI 48201-1436
(313) 831-2400
(313) 831-2445
Mailing address
500 E WARREN AVE, DETROIT, MI 48201-1436
(313) 831-2400
(313) 831-2445
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301007748
MI
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2046547
PK
—
05
—
2365220
—
MI
Enumeration date
11/17/2006
Last updated
01/18/2017
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