Provider Demographics
NPI:1821354168
Name:AZAAL DISCOUNT PHARMACY INC
Entity Type:Organization
Organization Name:AZAAL DISCOUNT PHARMACY INC
Other - Org Name:AZAAL DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BANDAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-872-0021
Mailing Address - Street 1:9834 CONANT ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3309
Mailing Address - Country:US
Mailing Address - Phone:313-872-0021
Mailing Address - Fax:313-872-0037
Practice Address - Street 1:9834 CONANT ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3309
Practice Address - Country:US
Practice Address - Phone:313-872-0021
Practice Address - Fax:313-872-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010098213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135148OtherPK
MI1821354168Medicaid