Healthcare Provider Details

I. General information

NPI: 1669173738
Provider Name (Legal Business Name): MEDMASTERS PHARMACY 1 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40784 RYAN RD
STERLING HEIGHTS MI
48310-1704
US

IV. Provider business mailing address

40784 RYAN RD
STERLING HEIGHTS MI
48310-1704
US

V. Phone/Fax

Practice location:
  • Phone: 586-800-8002
  • Fax:
Mailing address:
  • Phone: 586-800-8002
  • 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: ASMA M HASSAN
Title or Position: PHARMACIST IN CHARGE/OWNER
Credential: RPH
Phone: 610-390-3626