=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821180563
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MELVINDALE PHARMACY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2006
-----------------------------------------------------
Last Update Date | 02/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18287 ALLEN RD
-----------------------------------------------------
City | MELVINDALE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48122-1513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-386-0830
-----------------------------------------------------
Fax | 313-386-0907
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18287 ALLEN RD
-----------------------------------------------------
City | MELVINDALE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48122-1513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-386-0830
-----------------------------------------------------
Fax | 313-386-0907
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | MR. ALI RASHID ELHASAN
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 313-386-0830
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 5315011899
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 5301007596
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------