| NPI | 1861802456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOHSEN BAIDOUN Staff Pharmacist 313-974-1821 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: IL 051.295682) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2014-05-05 |