Healthcare Provider Details

I. General information

NPI: 1255869293
Provider Name (Legal Business Name): ANNAOM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11460 E 12 MILE RD
WARREN MI
48093-2631
US

IV. Provider business mailing address

1034 DORAL DR
TROY MI
48085-6130
US

V. Phone/Fax

Practice location:
  • Phone: 586-722-2842
  • Fax: 586-279-1215
Mailing address:
  • Phone: 248-979-4324
  • 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: HITESHKUMAR RAMANLAL PATEL
Title or Position: PIC
Credential: RPH
Phone: 248-979-4324