Provider Demographics
NPI:1053836874
Name:LA VITA LLC
Entity Type:Organization
Organization Name:LA VITA LLC
Other - Org Name:HAMZEH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARM.D.
Authorized Official - Prefix:
Authorized Official - First Name:AZZAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSSAWEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-718-3705
Mailing Address - Street 1:10437 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1660
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10437 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126
Practice Address - Country:US
Practice Address - Phone:313-582-1670
Practice Address - Fax:313-582-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy