Provider Demographics
NPI:1619457264
Name:MD HILLER
Entity Type:Organization
Organization Name:MD HILLER
Other - Org Name:MDH COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ALIEDDIN
Authorized Official - Middle Name:KAMAL
Authorized Official - Last Name:ALAIWAT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:877-751-9010
Mailing Address - Street 1:2021 MONROE STREET
Mailing Address - Street 2:SUITE #103
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124
Mailing Address - Country:US
Mailing Address - Phone:877-751-9010
Mailing Address - Fax:248-436-4767
Practice Address - Street 1:2021 MONROE STREET
Practice Address - Street 2:SUITE #103
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:877-751-9010
Practice Address - Fax:248-436-4767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-14
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301011085333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy