Organization
MED MART PHARMACY 1 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALI BERRY (RPH)
(734) 992-8488
Entity
Organization
Contact information
Practice address
25850 EUREKA RD, TAYLOR, MI 48180-4924
(313) 283-2000
(313) 914-4699
Mailing address
13001 MICHIGAN AVE, DEARBORN, MI 48126-3553
(313) 283-2000
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568947018
—
MI
Enumeration date
10/01/2018
Last updated
12/20/2021
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