Organization
RED CROWN I I I INC
Active
Other names
RED CROWN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC GRAHAM (OWNER)
(810) 735-0800
Entity
Organization
Contact information
Practice address
635 W BROAD ST, LINDEN, MI 48451-8644
(810) 735-0800
(810) 735-0902
Mailing address
635 W BROAD ST, LINDEN, MI 48451-8644
(810) 735-0800
(810) 735-0902
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
MI
3336C0003X
Community/Retail Pharmacy
Primary
5301008602
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2365698
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
2365698
—
MI
Enumeration date
08/27/2006
Last updated
04/08/2008
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