Provider Demographics
NPI:1477821775
Name:GREATNESS LLC
Entity Type:Organization
Organization Name:GREATNESS LLC
Other - Org Name:PHARMACY 4 LESS II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BELIEF
Authorized Official - Middle Name:
Authorized Official - Last Name:EMADAMERHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-218-1786
Mailing Address - Street 1:PO BOX 5578
Mailing Address - Street 2:P.O.BOX 5578
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-0578
Mailing Address - Country:US
Mailing Address - Phone:313-372-4100
Mailing Address - Fax:313-372-4782
Practice Address - Street 1:13641 E 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-2257
Practice Address - Country:US
Practice Address - Phone:313-372-4100
Practice Address - Fax:313-372-4782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010096913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132831OtherPK
MI1477824775Medicaid
MI1477821775Medicaid