Organization
GREAT LAKES RX SAV MOR PHARMACY
Active
Other names
GREAT LAKES RX PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
WAEL KHANAFER (OWNER)
(133) 412-4622
Entity
Organization
Contact information
Practice address
1770 FORT ST, LINCOLN PARK, MI 48146-1904
(313) 827-9999
(313) 827-0999
Mailing address
1770 FORT ST, LINCOLN PARK, MI 48146-1904
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301008773
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2370702
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/26/2007
Last updated
05/08/2009
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