Healthcare Provider Details

I. General information

NPI: 1942022447
Provider Name (Legal Business Name): MATRIX PHARMACY LATHRUP VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26237 SOUTHFIELD RD STE B
LATHRUP VILLAGE MI
48076-4546
US

IV. Provider business mailing address

26237 SOUTHFIELD RD STE B
LATHRUP VILLAGE MI
48076-4546
US

V. Phone/Fax

Practice location:
  • Phone: 734-945-7506
  • Fax:
Mailing address:
  • Phone: 734-945-7506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MOHAMAD ELHAJIDIAB
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 248-234-5008