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General NPI Number Information
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NPI Number | 1245759521
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Entity Type | Organization
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Legal Business Name | WAYNE PHARMACY, LLC
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Dates
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Enumeration Date | 09/18/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 8275 N. WAYNE RD. SUITE B
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City | WESTLAND
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State | MI
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Zip | 48154
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Country | US
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Telephone | 734-525-6622
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Fax | 734-525-6681
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Provider Business Mailing Address
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Address Line | 8275 N WAYNE RD STE B
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City | WESTLAND
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State | MI
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Zip | 48185-1143
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Country | US
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Telephone | 734-525-6622
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MOHAMAD G. DIRANI
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Credential |
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Telephone | 734-525-6622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301011234
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License Number State | MI
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