| NPI | 1174079560 |
|---|---|
| Doing Business As | MEDSOURCE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | HADI DAGHER Owner, PIC, AO 313-717-2900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: MI 5301011057) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0004X Pharmacy Compounding Pharmacy | |
| Enumeration Date | 2016-08-26 |
| Last Update Date | 2017-01-18 |