| NPI | 1265687883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN CHARLES GAWRYK Pharmacy Director 313-224-7912 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2400X Clinic/Center Prison Health (Licence: MI 5301003163) |
| Enumeration Date | 2008-11-24 |
| Last Update Date | 2008-11-24 |