Organization
WATERFORD PHARMACY
Active
Other names
Waterford Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SAMMY SALEM (OWNER/PHARMACIST)
(313) 999-9499
Entity
Organization
Contact information
Practice address
5812 HIGHLAND, WATERFORD, MI 48328
(313) 891-2253
Mailing address
26630 CECILE ST, DEARBORN HEIGHTS, MI 48127-3330
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301009006
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2371944
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/26/2008
Last updated
11/26/2008
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