Organization
HURON RIVER PHARMACY LLC
Active
Other names
New Boston RX Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
AHMAD MOHAMAD-ALI RPH (OWNER/PIC)
(313) 300-4221
Entity
Organization
Contact information
Practice address
19162 HURON RIVER DR, NEW BOSTON, MI 48164-9727
(734) 753-2000
(734) 753-2002
Mailing address
19162 HURON RIVER DR, NEW BOSTON, MI 48164-9727
(734) 753-2000
(734) 753-2002
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301009771
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2376336
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/31/2011
Last updated
05/09/2012
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