Provider Demographics
NPI:1407262710
Name:HELIOPOLIS INVESTMENT GROUP LLC
Entity Type:Organization
Organization Name:HELIOPOLIS INVESTMENT GROUP LLC
Other - Org Name:NEWPORT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FATMEH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZLOUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-977-6006
Mailing Address - Street 1:7825 N DIXIE HWY
Mailing Address - Street 2:STE 105
Mailing Address - City:NEWPORT
Mailing Address - State:MI
Mailing Address - Zip Code:48166-9750
Mailing Address - Country:US
Mailing Address - Phone:734-872-1490
Mailing Address - Fax:734-872-1492
Practice Address - Street 1:7825 N DIXIE HWY STE 105
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:MI
Practice Address - Zip Code:48166-9750
Practice Address - Country:US
Practice Address - Phone:734-872-1490
Practice Address - Fax:734-872-1492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010104953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145670OtherPK