Provider Demographics
NPI:1346709714
Name:ETHANS GLOBAL LLC
Entity Type:Organization
Organization Name:ETHANS GLOBAL LLC
Other - Org Name:BLUE DOVE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MBWILLE
Authorized Official - Last Name:SAKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:734-667-1764
Mailing Address - Street 1:8653 N NEWBURGH RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1147
Mailing Address - Country:US
Mailing Address - Phone:734-667-1764
Mailing Address - Fax:
Practice Address - Street 1:8653 N NEWBURGH RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1147
Practice Address - Country:US
Practice Address - Phone:734-667-1764
Practice Address - Fax:734-335-7963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy