Organization
BEACON POINTE PHARMACY INC.
Active
Other names
Beacon Pointe Pharmacy Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
HASNA IWAS PHARM D (OWNER)
(586) 295-7221
Entity
Organization
Contact information
Practice address
15200 E JEFFERSON AVE, STE #102, GROSSE POINTE PARK, MI 48230-1304
(313) 822-5474
(313) 822-8780
Mailing address
15200 E JEFFERSON AVE, STE #102, GROSSE POINTE PARK, MI 48230-1304
(313) 822-5474
(313) 822-8780
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301006388
MI
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2040849
PK
—
05
—
3226861
—
MI
05
—
33226861
—
MI
Enumeration date
01/23/2007
Last updated
04/17/2019
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