Provider Demographics
NPI:1689189243
Name:HUNTINGTON PHARMACY
Entity Type:Organization
Organization Name:HUNTINGTON PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/PIC
Authorized Official - Prefix:
Authorized Official - First Name:USEF
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-779-8762
Mailing Address - Street 1:26711 WOODWARD AVE STE LL6
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1333
Mailing Address - Country:US
Mailing Address - Phone:248-951-2754
Mailing Address - Fax:248-951-2763
Practice Address - Street 1:26711 WOODWARD AVE # LL6
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1333
Practice Address - Country:US
Practice Address - Phone:313-779-8762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1689189243Medicaid