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General NPI Number Information
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NPI Number | 1609881259
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Entity Type | Organization
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Legal Business Name | MILLENNIUM SPECIALTY LTC
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 30141 CHERRY HILL RD
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City | INKSTER
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State | MI
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Zip | 48141
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Country | US
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Telephone | 734-721-2100
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Fax | 734-721-2702
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Provider Business Mailing Address
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Address Line | 30141 CHERRY HILL RD
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City | INKSTER
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State | MI
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Zip | 48141
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Country | US
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Telephone | 734-721-2100
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Fax | 734-721-2702
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Authorized Official
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Title or Position | TREASURER
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Name | MAHMOUD ABDEL-JAWAD
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Credential |
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Telephone | 248-906-9797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care 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 | 5301008540
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License Number State | MI
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