Provider Demographics
NPI:1114556859
Name:BUENA SALUD LLC
Entity Type:Organization
Organization Name:BUENA SALUD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:AMEED
Authorized Official - Middle Name:
Authorized Official - Last Name:NAHHAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-932-0198
Mailing Address - Street 1:7607 W VERNOR HWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-1513
Mailing Address - Country:US
Mailing Address - Phone:313-724-7555
Mailing Address - Fax:313-724-7556
Practice Address - Street 1:7607 W VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-1513
Practice Address - Country:US
Practice Address - Phone:313-724-7555
Practice Address - Fax:313-724-7556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-04
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1114556859Medicaid