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General NPI Number Information
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NPI Number | 1902105034
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Entity Type | Organization
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Legal Business Name | NILE FAMILY PHARMACY LLC
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Dates
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Enumeration Date | 03/15/2011
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Last Update Date | 07/01/2013
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Provider Practice Location Address
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Address Line | 70 E. STATE ST.
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City | NILES
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State | MI
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Zip | 49120
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Country | US
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Telephone | 269-683-1400
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Fax | 269-683-1402
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Provider Business Mailing Address
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Address Line | PO BOX 5157
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City | DEARBORN
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State | MI
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Zip | 48128-0157
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Country | US
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Telephone | 269-683-1400
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Fax | 269-683-1402
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Authorized Official
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Title or Position | OWNER
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Name | AIMAN KAWAS
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Credential |
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Telephone | 269-683-1400
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301009530
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License Number State | MI
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