Grand Gratiot Pharmacy, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

GRAND GRATIOT PHARMACY, LLC

Practice address

7011 Gratiot Ave Ste 100
Detroit, MI 48207-1973

Phone

(248) 663-3380

NPI assigned

Oct 31, 2020

Organization subpart

No

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

Authorized official

Name

Riyesah A Sahoubah

Title

Owner

Phone

(248) 663-3380

Specialties & licenses 1

Addresses

Other names 1

• PharMor Pharmacy-Grand Gratiot Doing business as

Locations

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

{
    "created_epoch": "1604102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604102400000",
    "number": "1508466194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7011 GRATIOT AVE STE 100",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482071973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7011 GRATIOT AVE STE 100",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482071973",
            "telephone_number": "248-663-3380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND GRATIOT PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-31",
        "last_updated": "2020-10-31",
        "certification_date": "2020-10-31",
        "status": "A",
        "authorized_official_last_name": "SAHOUBAH",
        "authorized_official_first_name": "RIYESAH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-663-3380"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PharMor Pharmacy-Grand Gratiot",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Peggy Lois Graham, LMSW
• Theodore K Graham, MD
• Ursula Graham, LPC
• Daniel Grahf, MD
• Kaitlyn Nicole Grambo, RDN, CNSC, CDCES
• Grand Greenfield Pharmacy, LLC
• Grand Lahser Pharmacy LLC
• Grand Mercy Pharmacy
• Grand Pharmacy
• Grand River Family Dentistry P.C.

• 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 Oct 31, 2020; 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.