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General NPI Number Information
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NPI Number | 1972741262
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Entity Type | Organization
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Legal Business Name | LEVAN MEDICAL PHARMACY LLC
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Dates
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Enumeration Date | 01/26/2009
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Last Update Date | 04/23/2010
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Provider Practice Location Address
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Address Line | 15132 LEVAN RD STE 32
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City | LIVONIA
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State | MI
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Zip | 48154-5027
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Country | US
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Telephone | 734-462-8005
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Fax | 734-462-8009
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Provider Business Mailing Address
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Address Line | 15132 LEVAN RD STE 32
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City | LIVONIA
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State | MI
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Zip | 48154-5027
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Country | US
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Telephone | 734-462-8005
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Fax | 734-462-8009
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Authorized Official
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Title or Position | MEMBER
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Name | MUSTAPHA HUSSEIN
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Credential | RPH
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Telephone | 734-462-8005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty 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 | 5301009050
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License Number State | MI
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