=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770162331
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DETROIT HOOVER PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2021
-----------------------------------------------------
Last Update Date | 10/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11538 EAST SEVEN MILES ROAD
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48234-4835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-354-5909
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4877 CATALINA DR
-----------------------------------------------------
City | LAKE ORION
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48359-2434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-354-5909
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER
-----------------------------------------------------
Name | MR. USMAN AHMAD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 586-354-5909
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------