=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255869293
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANNAOM INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11460 E 12 MILE RD
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48093-2631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-722-2842
-----------------------------------------------------
Fax | 586-279-1215
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1034 DORAL DR
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48085-6130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-979-4324
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PIC
-----------------------------------------------------
Name | HITESHKUMAR RAMANLAL PATEL
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 248-979-4324
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------