Provider Demographics
NPI:1437838026
Name:DETROIT RX LLC
Entity Type:Organization
Organization Name:DETROIT RX LLC
Other - Org Name:DETROIT RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DETROIT
Authorized Official - Middle Name:
Authorized Official - Last Name:RX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-800-0808
Mailing Address - Street 1:19268 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-1707
Mailing Address - Country:US
Mailing Address - Phone:313-800-0808
Mailing Address - Fax:313-800-7508
Practice Address - Street 1:19268 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-1707
Practice Address - Country:US
Practice Address - Phone:313-800-0808
Practice Address - Fax:313-800-7508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy