Provider Demographics
NPI:1033327754
Name:MILLENNIUM PHARMACY
Entity Type:Organization
Organization Name:MILLENNIUM PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:ALIDAH
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-451-5009
Mailing Address - Street 1:1102 ANN ARBOR RD W
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2131
Mailing Address - Country:US
Mailing Address - Phone:734-451-5009
Mailing Address - Fax:734-451-2413
Practice Address - Street 1:1102 ANN ARBOR RD W
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2131
Practice Address - Country:US
Practice Address - Phone:734-451-5009
Practice Address - Fax:734-451-2413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301007005261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4102279Medicaid