Healthcare Provider Details

I. General information

NPI: 1982928818
Provider Name (Legal Business Name): EAST VILLAGE PHARMAY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5728 SCHAEFER RD STE 102
DEARBORN MI
48126-2298
US

IV. Provider business mailing address

5728 SCHAEFER RD
DEARBORN MI
48126-2298
US

V. Phone/Fax

Practice location:
  • Phone: 313-581-4626
  • Fax: 313-581-4623
Mailing address:
  • Phone: 313-624-3016
  • Fax: 313-581-4623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301009315
License Number StateMI

VIII. Authorized Official

Name: HACHMIE ZEIN
Title or Position: PRESIDENT/OWNER/PIC
Credential: RPH
Phone: 313-581-4626