Organization
LONGACRES ANA INC
Active
Other names
Medina Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NASR MANSOUR (PRESIDENT)
(313) 397-6919
Entity
Organization
Contact information
Practice address
8744 W WARREN AVE, DEARBORN, MI 48126-4043
(313) 397-6919
(313) 397-9258
Mailing address
8744 W WARREN AVE, DEARBORN, MI 48126-4043
(313) 396-7691
(313) 397-9258
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301009552
MI
Other
Enumeration date
04/03/2011
Last updated
12/29/2016
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