Provider Demographics
NPI:1578719985
Name:GRAND PHARMACY
Entity Type:Organization
Organization Name:GRAND PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NAVEED
Authorized Official - Middle Name:
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-922-6666
Mailing Address - Street 1:751 E GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-2529
Mailing Address - Country:US
Mailing Address - Phone:313-922-2222
Mailing Address - Fax:313-922-8771
Practice Address - Street 1:751 E GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-2529
Practice Address - Country:US
Practice Address - Phone:313-922-6666
Practice Address - Fax:313-922-8771
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUALITY BEHAVIORAL HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010089123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy