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General NPI Number Information
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NPI Number | 1104919729
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Entity Type | Organization
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Legal Business Name | EXPRESS MEDS LLC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 28350 GRATIOT AVENUE
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City | ROSEVILLE
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State | MI
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Zip | 48066
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Country | US
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Telephone | 866-561-3018
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Fax | 586-776-2634
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Provider Business Mailing Address
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Address Line | 19785 WEST TWELVE MILE ROAD SUITE 488
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City | SOUTHFIELD
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State | MI
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Zip | 48076
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Country | US
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Telephone | 248-233-6511
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Fax | 248-233-6512
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Authorized Official
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Title or Position | PRESIDENT
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Name | JIDEOFOR N DALLAH
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Credential |
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Telephone | 248-233-6511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 5301008495
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License Number State | MI
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