Organization
FORT STREET PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN LEACH (OWNER AND PHCIST)
(313) 357-7500
Entity
Organization
Contact information
Practice address
2255 FORT ST, LINCOLN PARK, MI 48146-2671
(313) 357-7500
(313) 357-7502
Mailing address
PO BOX 46118, MOUNT CLEMENS, MI 48046-6118
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301004123
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1645190
—
MI
01
—
2339085
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
01/30/2007
Last updated
04/26/2011
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