Grand Lahser Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301010005 Issued in MI

Legal business name

GRAND LAHSER PHARMACY LLC

Practice address

21673 Grand River Ave
Detroit, MI 48219-3219

Phone

(313) 533-0500

Fax

(313) 533-0501

NPI assigned

Feb 12, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mohamed Sohoubah, PHR, SHRM-CP

Title

Member Owner

Phone

(248) 663-3380

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• PharMor Pharmacy- Grand Lahser Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ravi Nagalla

  • Pharmacist
  • Detroit, MI
  • NPI 1427545920
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1360627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436400000000",
    "number": "1508105404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21673 GRAND RIVER AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482193219",
            "telephone_number": "248-663-3380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21673 GRAND RIVER AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482193219",
            "telephone_number": "313-533-0500",
            "fax_number": "313-533-0501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND LAHSER PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-12",
        "last_updated": "2015-07-09",
        "status": "A",
        "authorized_official_last_name": "SOHOUBAH",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_title_or_position": "MEMBER OWNER",
        "authorized_official_telephone_number": "248-663-3380",
        "authorized_official_credential": "PHR, SHRM-CP"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301010005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508105404",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2138881",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PharMor Pharmacy- Grand Lahser",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ursula Graham, LPC
• Daniel Grahf, MD
• Kaitlyn Nicole Grambo, RDN, CNSC, CDCES
• Grand Gratiot Pharmacy, LLC
• Grand Greenfield Pharmacy, LLC
• Grand Mercy Pharmacy
• Grand Pharmacy
• Grand River Family Dentistry P.C.
• Grand River Health Center, PLC
• Grand River RX LLC

• Community/Retail Pharmacy in Detroit, MI
• Providers in Detroit, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.