Healthcare Provider Details

I. General information

NPI: 1306481015
Provider Name (Legal Business Name): OWOLABI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14726 CHAMPAIGN RD
ALLEN PARK MI
48101-1617
US

IV. Provider business mailing address

14726 CHAMPAIGN RD
ALLEN PARK MI
48101-1617
US

V. Phone/Fax

Practice location:
  • Phone: 313-382-0000
  • Fax: 313-382-0002
Mailing address:
  • Phone: 313-382-0000
  • Fax: 313-382-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALI HOJEIJ
Title or Position: OWNER
Credential: RPH
Phone: 313-382-0000