Healthcare Provider Details

I. General information

NPI: 1750214367
Provider Name (Legal Business Name): MEDICENA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 N CENTER RD
SAGINAW MI
48603-3730
US

IV. Provider business mailing address

2213 N CENTER RD
SAGINAW MI
48603-3730
US

V. Phone/Fax

Practice location:
  • Phone: 989-279-0079
  • Fax: 989-279-0077
Mailing address:
  • Phone: 989-279-0079
  • Fax: 989-279-0077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State

VIII. Authorized Official

Name: DILAFRUZ KUDRATOVA
Title or Position: OWNER
Credential:
Phone: 248-403-9680