Provider Demographics
NPI:1750636080
Name:MIINFA INC.
Entity Type:Organization
Organization Name:MIINFA INC.
Other - Org Name:SMART CHOICE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MUFUTAU
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEGUNLOLA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:313-491-7450
Mailing Address - Street 1:14379 LIVERNOIS AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-2507
Mailing Address - Country:US
Mailing Address - Phone:313-491-7450
Mailing Address - Fax:313-491-7451
Practice Address - Street 1:14379 LIVERNOIS AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-2507
Practice Address - Country:US
Practice Address - Phone:313-491-7450
Practice Address - Fax:313-491-7451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301009873333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy