| NPI | 1619131141 |
|---|---|
| Doing Business As | INDEPENDENT COMMUNITY PHARMACY |
| Entity Type | Organization |
| Authorized Contact | TOBORE UGBOSU Manager 313-931-2133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MI 5301008886) |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2008-07-14 |