Provider Demographics
NPI:1609881259
Name:MILLENNIUM SPECIALTY LTC
Entity Type:Organization
Organization Name:MILLENNIUM SPECIALTY LTC
Other - Org Name:NEW MILLENNIUM DRUGS TLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDEL-JAWAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-906-9797
Mailing Address - Street 1:30141 CHERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141
Mailing Address - Country:US
Mailing Address - Phone:734-721-2100
Mailing Address - Fax:734-721-2702
Practice Address - Street 1:30141 CHERRY HILL RD
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141
Practice Address - Country:US
Practice Address - Phone:734-721-2100
Practice Address - Fax:734-721-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010085403336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2042302OtherPK
MI4361646Medicaid
MI6501160001Medicare NSC