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General NPI Number Information
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NPI Number | 1124428412
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Entity Type | Organization
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Legal Business Name | ANATA LLC
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Dates
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Enumeration Date | 08/25/2014
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 9731 HARPER AVE
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City | DETROIT
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State | MI
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Zip | 48213-2700
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Country | US
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Telephone | 313-922-2900
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Fax | 313-922-2901
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Provider Business Mailing Address
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Address Line | 9731 HARPER AVE
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City | DETROIT
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State | MI
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Zip | 48213-2700
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Country | US
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Telephone | 313-922-2900
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Fax | 313-922-2901
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Authorized Official
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Title or Position | OWNER/PIC
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Name | MAHMOUD RIFAI
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Credential | RPH
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Telephone | 937-389-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301010529
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License Number State | MI
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