Healthcare Provider Details

I. General information

NPI: 1104136605
Provider Name (Legal Business Name): EZ RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1059 E 9 MILE ROAD
HAZEL PARK MI
48030-1855
US

IV. Provider business mailing address

1059 E 9 MILE RD
HAZEL PARK MI
48030-1855
US

V. Phone/Fax

Practice location:
  • Phone: 248-850-7196
  • Fax: 248-850-7081
Mailing address:
  • Phone: 248-850-7196
  • Fax: 248-850-7081

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 Number5301009991
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: FAHAD CHUDHRY
Title or Position: MEMBER-PRESIDENT
Credential:
Phone: 248-808-6929