Provider Demographics
NPI:1396361366
Name:GRAND GREENFIELD PHARMACY, LLC
Entity Type:Organization
Organization Name:GRAND GREENFIELD PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:WAGDI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-663-3380
Mailing Address - Street 1:14661 GREENFIELD RD STE B
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-2231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14661 GREENFIELD RD STE B
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-2231
Practice Address - Country:US
Practice Address - Phone:248-663-3380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy