Provider Demographics
NPI:1639720667
Name:GRAND HAVEN PHARMACY LLC
Entity Type:Organization
Organization Name:GRAND HAVEN PHARMACY LLC
Other - Org Name:GRAND HAVEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:AMEER
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-HAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-965-2181
Mailing Address - Street 1:930 JOHN R RD STE PHARMACY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-4316
Mailing Address - Country:US
Mailing Address - Phone:248-965-2181
Mailing Address - Fax:
Practice Address - Street 1:930 JOHN R RD STE PHARMACY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4316
Practice Address - Country:US
Practice Address - Phone:248-965-2181
Practice Address - Fax:248-965-2196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy