=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417665159
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONEWAY HAGER CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2022
-----------------------------------------------------
Last Update Date | 01/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4407 LIVERNOIS AVE
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48210-2437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-262-6541
-----------------------------------------------------
Fax | 313-262-6542
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4570 WALWIT ST
-----------------------------------------------------
City | DEARBORN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48126-3072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-310-7494
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHAR
-----------------------------------------------------
Name | AFAFF MOHAMED AHMED HAGERAHMA
-----------------------------------------------------
Credential | PHARMACIST
-----------------------------------------------------
Telephone | 313-310-7494
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------