Provider Demographics
NPI:1417738691
Name:LIFETIME RX OF DEARBORN HEIGHTS
Entity Type:Organization
Organization Name:LIFETIME RX OF DEARBORN HEIGHTS
Other - Org Name:LIFETIME RX OF DEARBORN HEIGHT LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HASAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SABBAGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-970-2458
Mailing Address - Street 1:4245 BEECH S BEECH DALY SUITE 101
Mailing Address - Street 2:
Mailing Address - City:DEARBRON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4245 BEECH S BEECH DALY SUITE 101
Practice Address - Street 2:
Practice Address - City:DEARBRON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125
Practice Address - Country:US
Practice Address - Phone:313-768-5037
Practice Address - Fax:313-768-5039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy