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General NPI Number Information
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NPI Number | 1386538692
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Entity Type | Organization
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Legal Business Name | MITTEN FAMILY PHARMACY LLC
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 3108 VAN HORN RD
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City | TRENTON
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State | MI
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Zip | 48183
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Country | US
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Telephone | 734-799-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 18227 COUNTRY CLUB CIR
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City | RIVERVIEW
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State | MI
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Zip | 48193-8162
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PIC
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Name | ALI AL-MAWLA
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Credential |
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Telephone | 734-799-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty 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 |
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License Number State |
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