Provider Demographics
NPI:1609233162
Name:LANSING SPECIALTY PHARMACY LLC
Entity Type:Organization
Organization Name:LANSING SPECIALTY PHARMACY LLC
Other - Org Name:CSA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:H
Authorized Official - Last Name:EL KHATIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-414-0249
Mailing Address - Street 1:1174 FORT ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-1895
Mailing Address - Country:US
Mailing Address - Phone:586-774-7294
Mailing Address - Fax:586-774-7298
Practice Address - Street 1:1174 FORT ST
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-1895
Practice Address - Country:US
Practice Address - Phone:586-774-7294
Practice Address - Fax:586-774-7298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MI53010107993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2381503Medicaid
MI2381503OtherNCPDP