| NPI | 1023309788 |
|---|---|
| Doing Business As | FAIRLANE MEDICAL PHARMACY |
| Entity Type | Organization |
| Authorized Contact | MOHAMMED IBRAHIM Member 313-526-8000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MI 5301009570) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336L0003X Pharmacy, Long Term Care Pharmacy | |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2011-06-22 |