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General NPI Number Information
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NPI Number | 1740199769
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Entity Type | Organization
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Legal Business Name | NOVA HEALTH PHARMACY LLC
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Dates
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Enumeration Date | 09/04/2026
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Last Update Date | 09/04/2026
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Provider Practice Location Address
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Address Line | 25775 W 10 MILE RD STE C
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City | SOUTHFIELD
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State | MI
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Zip | 48033-4856
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Country | US
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Telephone | 248-829-7799
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Fax | 248-829-7975
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Provider Business Mailing Address
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Address Line | 13700 E 12 MILE RD PMB 104
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City | WARREN
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State | MI
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Zip | 48088
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Country | US
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Telephone | 248-829-7799
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Fax | 248-829-7975
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Authorized Official
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Title or Position | OWNER
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Name | ABBAS MANSOUR
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Credential |
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Telephone | 248-829-7799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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