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General NPI Number Information
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NPI Number | 1750821849
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Entity Type | Organization
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Legal Business Name | ICAHN MANAGEMENT
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Dates
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Enumeration Date | 03/08/2017
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 200 ARNET ST STE 110
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City | YPSILANTI
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State | MI
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Zip | 48198-5753
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Country | US
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Telephone | 248-789-0999
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Fax |
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Provider Business Mailing Address
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Address Line | 200 ARNET ST STE 110
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City | YPSILANTI
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State | MI
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Zip | 48198-5753
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Country | US
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Telephone | 248-789-0999
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RASHA JIDDOU
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Credential |
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Telephone | 248-789-0999
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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 | 5301011101
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License Number State | MI
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