Organization
GOMAA LLC
Active
Other names
Medlife Rx
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMED GOMAA PHARMD (OWNER)
(201) 952-0660
Entity
Organization
Contact information
Practice address
2191 SOUTH BLVD STE 1B, AUBURN HILLS, MI 48326
(248) 791-7566
(248) 791-7567
Mailing address
2191 SOUTH BLVD STE 1B, AUBURN HILLS, MI 48326-3481
(248) 791-7566
(248) 791-7567
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301010999
MI
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205282266
—
MI
01
—
2160129
PK
—
Enumeration date
05/09/2016
Last updated
07/13/2018
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