Organization
GRACE MEDICAL PHARMACY LLC
Active
Other names
GRACE MEDICAL PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MUYIWA JOHN SULE (PHARMACIST/PRESIDENT)
(248) 346-4480
Entity
Organization
Contact information
Practice address
20805 GRAND RIVER AVE, DETROIT, MI 48219-3919
(313) 255-2300
(313) 255-2307
Mailing address
20805 GRAND RIVER AVE, DETROIT, MI 48219-3919
(313) 255-2300
(313) 255-2307
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301010188
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457787921
—
MI
01
—
2142091
PK
—
Enumeration date
09/17/2013
Last updated
06/08/2022
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