Organization
RED CAP PHARMACY 001 LLC
Active
Other names
Red Cap Pharmacy 001
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMAD ISSA ABOUKHODR (OWNER)
(517) 879-4877
Entity
Organization
Contact information
Practice address
214 N WEST AVE STE A, JACKSON, MI 49201-1903
(517) 879-4877
(517) 879-1873
Mailing address
214 N. WEST AVE STE A, JACKSON, MI 49201
(517) 879-4877
(517) 879-1873
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301011054
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2166443
PK
—
Enumeration date
11/29/2016
Last updated
01/09/2023
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