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General NPI Number Information
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NPI Number | 1376797746
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Entity Type | Organization
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Legal Business Name | 123 PHARMACY LLC
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 05/02/2011
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Provider Practice Location Address
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Address Line | 24142 W WARREN ST STE A2
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-2256
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Country | US
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Telephone | 313-730-0677
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Fax | 313-730-0670
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Provider Business Mailing Address
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Address Line | 24142 W WARREN ST STE A2
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-2256
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Country | US
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Telephone | 313-730-0677
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Fax | 313-730-0670
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Authorized Official
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Title or Position | PRESIDENT
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Name | MUSTAPHA HUSSEIN
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Credential |
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Telephone | 313-645-7544
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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 | 5315038557
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License Number State | MI
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