Provider Demographics
NPI:1578109377
Name:VENOY FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:VENOY FAMILY PHARMACY LLC
Other - Org Name:EXECUTIVE CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-485-0111
Mailing Address - Street 1:17000 EXECUTIVE PLAZA DR STE 104
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2793
Mailing Address - Country:US
Mailing Address - Phone:313-634-4858
Mailing Address - Fax:313-908-1184
Practice Address - Street 1:17000 EXECUTIVE PLAZA DR STE 104
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2793
Practice Address - Country:US
Practice Address - Phone:313-634-4858
Practice Address - Fax:313-908-1184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy