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Organization
LAKEWOOD FAMILY PHARMACY LLC
Active
Organization
LAKEWOOD FAMILY PHARMACY LLC
Active
Other names
DEARBORN FAMILY PHARMACY LTC
Organization subpart
No
Provider details
NPI number
Authorized official
HASSAN ISMAIL B.S PHARMACY (OWNER)
(313) 982-3770
Entity
Organization
Contact information
Practice address
17000 EXECUTIVE PLAZA DR STE 209, DEARBORN, MI 48126-2793
(313) 982-3770
(313) 982-3771
Mailing address
17000 EXECUTIVE PLAZA DR STE 209, DEARBORN, MI 48126-2793
(313) 982-3770
(313) 982-3771
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
5301011107
MI
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
3336S0011X
Specialty Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2383052
—
MI
Enumeration date
02/27/2017
Last updated
01/23/2024
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