Organization
PREMIER HOME PHARMACY OF MI
Active
Other names
Premier Home Pharmacy of MI
Organization subpart
No
Provider details
NPI number
Authorized official
SYED RAZA (OWNER)
(734) 658-8985
Entity
Organization
Contact information
Practice address
23874 KEAN ST, SUITE 120, DEARBORN, MI 48124-1804
(313) 887-9111
(313) 887-4229
Mailing address
23874 KEAN ST, SUITE 120, DEARBORN, MI 48124-1804
(313) 887-9111
(313) 887-4229
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301010075
MI
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831441971
—
MI
01
—
2137422
PK
—
Enumeration date
10/13/2012
Last updated
03/02/2016
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