| NPI | 1124157052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAHMOUD M RIFAI Pharmacist 313-252-2400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MI 5301008585) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2020-08-22 |