Organization
HIGHLAND PARK GLORY PHARMACY LLC
Active
Other names
PHARMOR PHARMACY- HIGHLAND PARK
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMED SOHOUBAH (OWNER)
(248) 663-3380
Entity
Organization
Contact information
Practice address
23815 NORTHWESTERN HWY STE 120, SOUTHFIELD, MI 48075-7738
(248) 996-8441
(248) 996-8827
Mailing address
23815 NORTHWESTERN HWY, SUITE 120, SOUTHFIELD, MI 48075-7738
(248) 996-8441
(248) 996-8827
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301010044
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821439621
—
MI
01
—
2141090
PK
—
Enumeration date
07/10/2013
Last updated
10/12/2016
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