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
—
—
3336C0003X
Community/Retail Pharmacy
5301011107
MI
3336L0003X
Long Term Care Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
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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