Organization
PINE KNOB PHARMACY #3, INC.
Active
Other names
Sav-Mor #38 Pine Knob #3
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAY ALEXANDER BULLARD R.PH. (PRESIDENT)
(248) 620-3588
Entity
Organization
Contact information
Practice address
6770 DIXIE HIGHWAY, SUITE 201, CLARKSTON, MI 48346
(248) 620-3588
(248) 620-0037
Mailing address
6770 DIXIE HIGHWAY, SUITE 201, CLARKSTON, MI 48346
(248) 620-3588
(248) 620-0037
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301006232
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2354126
OTHER ID NUMBER
—
Enumeration date
08/27/2006
Last updated
10/27/2016
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