Provider Demographics
NPI:1912523986
Name:GRATIOT SEVEN PHARMACY, LLC
Entity type:Organization
Organization Name:GRATIOT SEVEN PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAWARI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:313-458-7379
Mailing Address - Street 1:12740 GRATIOT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-3944
Mailing Address - Country:US
Mailing Address - Phone:313-458-7379
Mailing Address - Fax:313-458-7385
Practice Address - Street 1:12740 GRATIOT AVE STE 100
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-3944
Practice Address - Country:US
Practice Address - Phone:313-458-7379
Practice Address - Fax:313-458-7385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy