Provider Demographics
NPI:1861817975
Name:H & P FOOD TOWN PHARMACY INC
Entity Type:Organization
Organization Name:H & P FOOD TOWN PHARMACY INC
Other - Org Name:VALUE CENTER PHARMACY III
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,AO
Authorized Official - Prefix:
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUTROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-724-2401
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-0543
Mailing Address - Country:US
Mailing Address - Phone:248-361-6868
Mailing Address - Fax:248-644-5576
Practice Address - Street 1:7300 HIGHLAND RD STE A
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1508
Practice Address - Country:US
Practice Address - Phone:248-724-2401
Practice Address - Fax:248-724-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010107113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144671OtherPK
5578250003Medicare NSC
5578250002Medicare NSC