Organization
REDFORD PHARMACY INC
Active
Other names
Redford Pharmacy, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMMAD ETTAHER (OWNER)
(313) 532-8224
Entity
Organization
Contact information
Practice address
17364 LAHSER RD, DETROIT, MI 48219-2348
(313) 532-5920
(313) 532-8224
Mailing address
17364 LAHSER RD, DETROIT, MI 48219-2348
(313) 532-5920
(313) 532-8224
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301009740
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2311239
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
2311239
—
MI
Enumeration date
11/07/2006
Last updated
04/26/2012
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