Provider Demographics
NPI:1790014819
Name:MINAL PHARMACY LLC
Entity Type:Organization
Organization Name:MINAL PHARMACY LLC
Other - Org Name:MINAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC,R.PH
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:SAEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-764-3302
Mailing Address - Street 1:13031 CONANT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48212-2361
Mailing Address - Country:US
Mailing Address - Phone:313-893-3339
Mailing Address - Fax:313-893-3337
Practice Address - Street 1:13031 CONANT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-2361
Practice Address - Country:US
Practice Address - Phone:313-893-3339
Practice Address - Fax:313-893-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-19
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010092603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2123205OtherPK