Organization
SUPER VALUE PHARMACY
Active
Other names
super value pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SRINIVAS PATHURI (MANAGER)
(248) 591-0050
Entity
Organization
Contact information
Practice address
825 W 9 MILE RD, FERNDALE, MI 48220-1267
(248) 591-0050
(248) 591-0080
Mailing address
825 W 9 MILE RD, FERNDALE, MI 48220-1267
(248) 591-0050
(248) 591-0080
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
530100933
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2373835
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/09/2010
Last updated
04/09/2010
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