Provider Demographics
NPI: | 1518405000 |
---|---|
Name: | ZEST FOR LIFE LLC |
Entity Type: | Organization |
Organization Name: | ZEST FOR LIFE LLC |
Other - Org Name: | THE MEDICINE CABINET |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | FALGUNI |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | AMIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 248-557-8840 |
Mailing Address - Street 1: | 27159 GREENFIELD RD |
Mailing Address - Street 2: | |
Mailing Address - City: | SOUTHFIELD |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48076-5135 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 248-557-8840 |
Mailing Address - Fax: | 248-569-0646 |
Practice Address - Street 1: | 27159 GREENFIELD RD |
Practice Address - Street 2: | |
Practice Address - City: | SOUTHFIELD |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48076-5135 |
Practice Address - Country: | US |
Practice Address - Phone: | 248-557-8840 |
Practice Address - Fax: | 248-569-0646 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-02-06 |
Last Update Date: | 2017-02-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 5301011097 | 3336C0003X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |