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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