Healthcare Provider Details

I. General information

NPI: 1609881259
Provider Name (Legal Business Name): MILLENNIUM SPECIALTY LTC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 10/04/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30141 CHERRY HILL RD
INKSTER MI
48141
US

IV. Provider business mailing address

30141 CHERRY HILL RD
INKSTER MI
48141
US

V. Phone/Fax

Practice location:
  • Phone: 734-721-2100
  • Fax: 734-721-2702
Mailing address:
  • Phone: 734-721-2100
  • Fax: 734-721-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301008540
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MAHMOUD ABDEL-JAWAD
Title or Position: TREASURER
Credential:
Phone: 248-906-9797