Organization
PARK PHARMACY SCS LLC
Active
Organization
PARK PHARMACY SCS LLC
Active
Other names
PARK PHARMACY SCS
Organization subpart
No
Provider details
NPI number
Authorized official
NASSAR BEYDOUN (OWNER)
(313) 999-8560
Entity
Organization
Contact information
Practice address
20225 E 9 MILE RD STE 120A, SAINT CLAIR SHORES, MI 48080
(586) 447-5189
(586) 774-7187
Mailing address
20225 E 9 MILE RD STE 120A, SAINT CLAIR SHORES, MI 48080-1700
(586) 447-5189
(586) 774-7187
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301011114
MI
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2170711
PK
—
Enumeration date
04/05/2017
Last updated
11/08/2018
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