Provider Demographics
NPI:1891266607
Name:SAINT CLAIR SHORES PHARMACY LLC
Entity Type:Organization
Organization Name:SAINT CLAIR SHORES PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:RESLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:586-350-0370
Mailing Address - Street 1:23600 HARPER AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1445
Mailing Address - Country:US
Mailing Address - Phone:586-350-0370
Mailing Address - Fax:586-350-0375
Practice Address - Street 1:23600 HARPER AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1445
Practice Address - Country:US
Practice Address - Phone:586-350-0370
Practice Address - Fax:586-350-0375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy