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Organization
DEARBORN FAMILY PHARMACY LLC
Active
Organization
DEARBORN FAMILY PHARMACY LLC
Active
Other names
Family Pharmacy LTC
Organization subpart
No
Provider details
NPI number
Authorized official
AIMAN ABUEIDA (OWNER)
(313) 523-5334
Entity
Organization
Contact information
Practice address
17000 EXECUTIVE PLAZA DR, SUITE 104, DEARBORN, MI 48126-2610
(313) 982-3770
(313) 982-3771
Mailing address
17000 EXECUTIVE PLAZA DR, SUITE 104, DEARBORN, MI 48126-2610
(313) 982-3770
(313) 982-3771
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
5301009879
MI
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2377237
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/23/2012
Last updated
09/22/2014
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