Healthcare Provider Details

I. General information

NPI: 1558853770
Provider Name (Legal Business Name): SAFEWAY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25222 GREENFIELD RD
OAK PARK MI
48237-4032
US

IV. Provider business mailing address

5908 WILLIAMSON ST
DEARBORN MI
48126-2171
US

V. Phone/Fax

Practice location:
  • Phone: 313-632-9920
  • Fax: 313-632-9920
Mailing address:
  • Phone: 313-632-9920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301011403
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HILAL NAHLE
Title or Position: OWNER
Credential:
Phone: 313-632-9920