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General NPI Number Information
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NPI Number | 1316361819
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Entity Type | Organization
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Legal Business Name | MA HOME LLC
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Dates
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Enumeration Date | 02/05/2014
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Last Update Date | 08/26/2019
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Provider Practice Location Address
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Address Line | 5575 CONNER ST STE 103
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City | DETROIT
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State | MI
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Zip | 48213-6400
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Country | US
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Telephone | 313-571-3095
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Fax | 313-571-3942
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Provider Business Mailing Address
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Address Line | 5575 CONNER ST STE 103
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City | DETROIT
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State | MI
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Zip | 48213-6400
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Country | US
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Telephone | 313-571-3095
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Fax | 313-571-3942
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Authorized Official
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Title or Position | OWNER
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Name | AHMAD SAYED
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Credential | PHARMD
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Telephone | 313-571-3095
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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 | 5301010645
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License Number State | MI
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