NPI 1083770978
Specialty Medicine Compounding Pharmacy
Practice location
- Address
- 350 S Lafayette St, South Lyon, MI 48178-1814
- Phone
- (248) 446-2643
- Fax
- (248) 486-1906
Authorised official
- Name
- Kenny Ray Walkup
- Title
- Owner
- Phone
- (248) 446-2643
Registered specialties
Compounding Pharmacy
Primary
Registry record
- NPI
- 1083770978
- Entity type
- Organization
- NPI issued
- 28 Dec 2006
- Record last updated
- 19 Apr 2013
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.