Provider Demographics
NPI:1952463663
Name:LIVONIA DRUGS INC.
Entity Type:Organization
Organization Name:LIVONIA DRUGS INC.
Other - Org Name:LIVONIA DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISAM
Authorized Official - Middle Name:ESA
Authorized Official - Last Name:SALAH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:734-421-3784
Mailing Address - Street 1:33525 5 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-2861
Mailing Address - Country:US
Mailing Address - Phone:734-421-3784
Mailing Address - Fax:734-421-3822
Practice Address - Street 1:33525 5 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-2861
Practice Address - Country:US
Practice Address - Phone:734-421-3784
Practice Address - Fax:734-421-3822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010022603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5301002260OtherSTATE LICENSE