=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699883066
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JANS DISCOUNT PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2006
-----------------------------------------------------
Last Update Date | 08/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 HAGGERTY RD STE 1070
-----------------------------------------------------
City | WEST BLOOMFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48323-2184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-668-1212
-----------------------------------------------------
Fax | 248-668-8453
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2300 HAGGERTY RD STE 1070
-----------------------------------------------------
City | WEST BLOOMFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48323-2185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-668-1212
-----------------------------------------------------
Fax | 248-668-8453
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHARMACIST IN CHARGE
-----------------------------------------------------
Name | KHALIL CHAHINE
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 248-668-1212
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 5301010346
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------