Organization
EASTSIDE DISCOUNT PHARMACY
Active
Organization
EASTSIDE DISCOUNT PHARMACY
Active
Other names
EASTSIDE DISCOUNT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MAHMOND FOUDOUS (PHARMACIST)
(313) 433-5578
Entity
Organization
Contact information
Practice address
14366 GRATIOT AVE, STE 100, DETROIT, MI 48205-2307
(313) 839-2000
(313) 839-2003
Mailing address
14366 GRATIOT AVE, STE 100, DETROIT, MI 48205-2307
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301008846
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2371021
OTHER ID NUMBER
—
Enumeration date
04/15/2008
Last updated
06/17/2008
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