Provider Demographics
NPI:1558853770
Name:SAFEWAY PHARMACY LLC
Entity Type:Organization
Organization Name:SAFEWAY PHARMACY LLC
Other - Org Name:SAFEWAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HILAL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAHLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-632-9920
Mailing Address - Street 1:5908 WILLIAMSON ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2171
Mailing Address - Country:US
Mailing Address - Phone:313-632-9920
Mailing Address - Fax:
Practice Address - Street 1:25222 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-4032
Practice Address - Country:US
Practice Address - Phone:313-632-9920
Practice Address - Fax:313-632-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301011403333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176774OtherPK