Healthcare Provider Details

I. General information

NPI: 1831780683
Provider Name (Legal Business Name): LIVONIA EXPRESS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28275 FIVE MILE RD
LIVONIA MI
48154-3998
US

IV. Provider business mailing address

28275 FIVE MILE RD
LIVONIA MI
48154-3998
US

V. Phone/Fax

Practice location:
  • Phone: 313-674-5968
  • Fax: 313-406-6783
Mailing address:
  • Phone: 734-237-4949
  • Fax: 313-406-6783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SAHER ABDULMALEK
Title or Position: OWNER
Credential:
Phone: 313-674-5968