Healthcare Provider Details

I. General information

NPI: 1447734496
Provider Name (Legal Business Name): INTEGRATED HEALTH PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2018
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49650 CHERRY HILL RD.
CANTON MI
48187
US

IV. Provider business mailing address

49650 CHERRY HILL RD.
CANTON MI
48187
US

V. Phone/Fax

Practice location:
  • Phone: 313-415-6078
  • Fax:
Mailing address:
  • Phone: 313-415-6078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMED FAWAZ
Title or Position: OWNER/AGENT
Credential:
Phone: 734-961-8885