Healthcare Provider Details

I. General information

NPI: 1740199769
Provider Name (Legal Business Name): NOVA HEALTH PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25775 W 10 MILE RD STE C
SOUTHFIELD MI
48033-4856
US

IV. Provider business mailing address

13700 E 12 MILE RD PMB 104
WARREN MI
48088
US

V. Phone/Fax

Practice location:
  • Phone: 248-829-7799
  • Fax: 248-829-7975
Mailing address:
  • Phone: 248-829-7799
  • Fax: 248-829-7975

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: ABBAS MANSOUR
Title or Position: OWNER
Credential:
Phone: 248-829-7799