Organization
GBOGBARA INC
Active
Other names
King Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LENYIE N NGBOGBARA (PRESIDENT)
(313) 331-8484
Entity
Organization
Contact information
Practice address
12871 E JEFFERSON, DETROIT, MI 48215-2754
(313) 331-8484
(313) 331-1864
Mailing address
12871 E JEFFERSON, DETROIT, MI 48215-2754
(313) 331-8484
(313) 331-1864
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301006276
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3155302
—
MI
Enumeration date
08/31/2006
Last updated
12/09/2020
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