1616 Ford Ave Drugs Inc
Organization Active NPI Community/Retail Pharmacy · Wyandotte, MI
NPI 1295849214 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1295849214
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 5301006574 (MI)
- Legal business name
- 1616 FORD AVE DRUGS INC
- Practice address
- 1616 Ford Ave
Wyandotte, MI 48192-2304 - Phone
- (734) 285-3111
- Fax
- (734) 285-8258
- NPI assigned
- Aug 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Petar Dimovich, R.PH.
- Title
- Vice President
- Phone
- (734) 285-3111
Practitioners 1
-
Petar Dimovich, R.PH.
National Provider Directory
Locations
1616 Ford Ave
Wyandotte, MI 48192
Phone (734) 285-3111
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 5301006574 | MI | Yes |
Addresses
Primary practice location
1616 Ford Ave
Wyandotte, MI 48192-2304
Mailing address
1616 Ford Ave
Wyandotte, MI 48192-2304
Phone (734) 285-3111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2356978 | Medicaid | MI | |
| 2356978 | Other | MI | NCPDP |
Other names
- Wyandotte Action Drugs
Other providers in Wyandotte, MI
All providers in Wyandotte, MI · Community/Retail Pharmacy in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.