Healthcare Provider Details

I. General information

NPI: 1245368901
Provider Name (Legal Business Name): SAV MAX GLORY #2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 WOODWARD AVE
HIGHLAND PARK MI
48203-2936
US

IV. Provider business mailing address

14100 WOODWARD AVE
HIGHLAND PARK MI
48203-2936
US

V. Phone/Fax

Practice location:
  • Phone: 313-252-2400
  • Fax: 313-252-2459
Mailing address:
  • Phone: 313-252-2400
  • Fax: 313-252-2459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301009178
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MAHMOUND RIFAI
Title or Position: PRESIDENT
Credential:
Phone: 313-347-6022