Provider Demographics
NPI:1497280259
Name:DUNDEE FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:DUNDEE FAMILY PHARMACY LLC
Other - Org Name:DUNDEE FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDUL-HADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-995-1174
Mailing Address - Street 1:340 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1208
Mailing Address - Country:US
Mailing Address - Phone:313-615-1016
Mailing Address - Fax:
Practice Address - Street 1:2925 RUSSELL ST STE 100
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4825
Practice Address - Country:US
Practice Address - Phone:313-462-4828
Practice Address - Fax:313-462-4804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301011158333600000X, 3336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6074993Medicaid