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Organization

LANSING SPECIALTY PHARMACY LLC

Active
Other names
CSA PHARMACY, Lansing Specialty Pharmacy
Organization subpart
No

Provider details

NPI number
Authorized official
ALI H EL KHATIB (OWNER)
(313) 414-0249
Entity
Organization

Contact information

Practice address
1174 FORT ST, LINCOLN PARK, MI 48146-1895
(586) 774-7294
(586) 774-7298
Mailing address
1174 FORT ST, LINCOLN PARK, MI 48146-1895
(586) 774-7294
(586) 774-7298

Taxonomy

Speciality
Code
Description
License number
State
333600000X
Pharmacy
3336C0003X
Community/Retail Pharmacy
5301010799
MI
3336L0003X
Long Term Care Pharmacy
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2381503
NCPDP
MI
05
2381503
MI
Enumeration date
01/28/2016
Last updated
12/07/2020
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