Provider Demographics
NPI:1245759521
Name:WAYNE PHARMACY, LLC
Entity Type:Organization
Organization Name:WAYNE PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIRANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-525-6622
Mailing Address - Street 1:8275 N WAYNE RD STE B
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1143
Mailing Address - Country:US
Mailing Address - Phone:734-525-6622
Mailing Address - Fax:
Practice Address - Street 1:8275 N. WAYNE RD. SUITE B
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48154
Practice Address - Country:US
Practice Address - Phone:734-525-6622
Practice Address - Fax:734-525-6681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010112343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy