Provider Demographics
NPI:1598220501
Name:ADONAI PHARMACY LLC
Entity Type:Organization
Organization Name:ADONAI PHARMACY LLC
Other - Org Name:ADONAI PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:ORUESEFIETA
Authorized Official - Last Name:BOKAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-258-1826
Mailing Address - Street 1:13641 E 7 MILE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-2257
Mailing Address - Country:US
Mailing Address - Phone:313-372-4100
Mailing Address - Fax:313-625-6800
Practice Address - Street 1:13641 E 7 MILE RD STE 2
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:313-625-6800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1598220501Medicaid