Provider Demographics
NPI:1003178948
Name:AL AMIR PHARMACY LLC
Entity Type:Organization
Organization Name:AL AMIR PHARMACY LLC
Other - Org Name:AL AMIR PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSHAFEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-447-7327
Mailing Address - Street 1:15210 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1356
Mailing Address - Country:US
Mailing Address - Phone:313-436-1785
Mailing Address - Fax:313-436-1786
Practice Address - Street 1:15210 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1356
Practice Address - Country:US
Practice Address - Phone:313-436-1785
Practice Address - Fax:313-436-1786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
MI53010100373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1003178948Medicaid
2138990OtherPK