Organization
DETROIT PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IBRAHIM A CHAMI RPH (OWNER PHCST)
(734) 262-4600
Entity
Organization
Contact information
Practice address
18925 GRAND RIVER AVE, DETROIT, MI 48223-2273
(313) 272-1400
(313) 272-3816
Mailing address
PO BOX 530815, LIVONIA, MI 48153-0815
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301007942
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2366107
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
2366107
—
MI
Enumeration date
12/06/2006
Last updated
12/18/2007
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