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General NPI Number Information
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NPI Number | 1548712979
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Entity Type | Organization
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Legal Business Name | EXECUTIVE INFUSION SERVICES LLC
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Dates
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Enumeration Date | 11/02/2016
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 12821 D-13 S. SAQINAW ST
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City | GRAND BLANK
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State | MI
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Zip | 48439
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Country | US
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Telephone | 313-982-3220
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Fax | 313-982-3221
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Provider Business Mailing Address
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Address Line | 17000 EXECUTIVE PLAZA DR SUITE 201 - B
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City | DEARBORN
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State | MI
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Zip | 48126-2793
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Country | US
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Telephone | 313-982-3221
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Fax | 313-982-3221
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Authorized Official
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Title or Position | OWNER / CLINICAL PHARMACIST
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Name | AIMAN ABUEIDA
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Credential |
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Telephone | 313-982-3220
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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 | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 5301010096
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License Number State | MI
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