Provider Demographics
NPI:1306412242
Name:MADINA PHARMACY LLC
Entity Type:Organization
Organization Name:MADINA PHARMACY LLC
Other - Org Name:MADINA PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALHUSAINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-782-4099
Mailing Address - Street 1:8715 JOSEPH CAMPAU ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8715 JOSEPH CAMPAU ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3720
Practice Address - Country:US
Practice Address - Phone:313-405-3591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy