| NPI | 1851493381 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMEKA BACON Owner 734-649-0762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MI 5301008463) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2013-09-13 |