Healthcare Provider Details

I. General information

NPI: 1386538692
Provider Name (Legal Business Name): MITTEN FAMILY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3108 VAN HORN RD
TRENTON MI
48183
US

IV. Provider business mailing address

18227 COUNTRY CLUB CIR
RIVERVIEW MI
48193-8162
US

V. Phone/Fax

Practice location:
  • Phone: 734-799-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: ALI AL-MAWLA
Title or Position: OWNER/PIC
Credential:
Phone: 734-799-9000