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| Type | Company | [sources] | |||
|---|---|---|---|---|---|
| Name | Divine Pharmacy LLC | [sources] | |||
| Incorporation date | not available | [sources] | |||
| Jurisdiction | not available | [sources] | |||
| Country | United States | [sources] | |||
| Description | License number: 5301010794 | [sources] | |||
| NPI | 1003273202 | [sources] | |||
| Registration number | not available | [sources] | |||
| Sector | Pharmacy | [sources] | |||
| Address | Detroit, MI | [sources] | |||
| Last change | Last processed | First seen | |||
Providers who have been terminated for cause from Michigan's Medicaid program.
United States · MDHHS
us-medmi-8ed1d8b2301844aec107c0142b17152cab301b26 · us-npi-1003273202For experts: raw data explorer
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