Provider Demographics
NPI:1265719892
Name:DOWNRIVER DRUGS
Entity type:Organization
Organization Name:DOWNRIVER DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLEIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-578-1189
Mailing Address - Street 1:4045 DIX HWY
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-3934
Mailing Address - Country:US
Mailing Address - Phone:313-294-6666
Mailing Address - Fax:
Practice Address - Street 1:4045 DIX HWY
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-3934
Practice Address - Country:US
Practice Address - Phone:313-294-6666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010096893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy