Provider Demographics
NPI:1437609351
Name:BLOOMS PHARMACY LLC
Entity Type:Organization
Organization Name:BLOOMS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEAITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-469-4657
Mailing Address - Street 1:16347 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3360
Mailing Address - Country:US
Mailing Address - Phone:734-469-4657
Mailing Address - Fax:888-867-9794
Practice Address - Street 1:16347 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3360
Practice Address - Country:US
Practice Address - Phone:734-469-4657
Practice Address - Fax:888-867-9794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010110563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy