Provider Demographics
NPI:1821180563
Name:MELVINDALE PHARMACY INC.
Entity Type:Organization
Organization Name:MELVINDALE PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:RASHID
Authorized Official - Last Name:ELHASAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-386-0830
Mailing Address - Street 1:18287 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:MELVINDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48122-1513
Mailing Address - Country:US
Mailing Address - Phone:313-386-0830
Mailing Address - Fax:313-386-0907
Practice Address - Street 1:18287 ALLEN RD
Practice Address - Street 2:
Practice Address - City:MELVINDALE
Practice Address - State:MI
Practice Address - Zip Code:48122-1513
Practice Address - Country:US
Practice Address - Phone:313-386-0830
Practice Address - Fax:313-386-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315011899333600000X
MI53010075963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2364254OtherNCPDP
MI540H20025OtherBCBSM DME
MI874503661Medicaid
MI=========OtherPPOM
MI874503661Medicaid