Organization
123 PHARMACY LLC
Active
Other names
123 Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MUSTAPHA HUSSEIN (PRESIDENT)
(313) 645-7544
Entity
Organization
Contact information
Practice address
24142 W WARREN ST, STE A2, DEARBORN HEIGHTS, MI 48127-2256
(313) 730-0677
(313) 730-0670
Mailing address
24142 W WARREN ST, STE A2, DEARBORN HEIGHTS, MI 48127-2256
(313) 730-0677
(313) 730-0670
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5315038557
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2371867
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/11/2008
Last updated
05/02/2011
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