Provider Demographics
NPI:1417327966
Name:LAHSER MEDICAL CENTER PHARMACY LLC
Entity Type:Organization
Organization Name:LAHSER MEDICAL CENTER PHARMACY LLC
Other - Org Name:LAHSER MEDICAL CAMPUS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC/AO
Authorized Official - Prefix:DR
Authorized Official - First Name:HADY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEYDOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-844-7447
Mailing Address - Street 1:27207 LAHSER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-2168
Mailing Address - Country:US
Mailing Address - Phone:248-262-7679
Mailing Address - Fax:248-262-7973
Practice Address - Street 1:27207 LAHSER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-2168
Practice Address - Country:US
Practice Address - Phone:248-262-7679
Practice Address - Fax:248-262-7973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-27
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010108043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155596OtherPK