Provider Demographics
NPI:1609310937
Name:NEW SEVEN MILE PHARMACY LLC
Entity Type:Organization
Organization Name:NEW SEVEN MILE PHARMACY LLC
Other - Org Name:NEW SEVEN MILE PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-245-9920
Mailing Address - Street 1:PO BOX 7160
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48121-7160
Mailing Address - Country:US
Mailing Address - Phone:313-245-9920
Mailing Address - Fax:313-245-9921
Practice Address - Street 1:14400 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-2307
Practice Address - Country:US
Practice Address - Phone:313-245-9920
Practice Address - Fax:313-245-9921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010110713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166532OtherPK