Provider Demographics
NPI:1972140499
Name:VILLAGE PHARMACY COMPOUNDING 3 INC
Entity Type:Organization
Organization Name:VILLAGE PHARMACY COMPOUNDING 3 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GABLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAWAIDEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-723-4444
Mailing Address - Street 1:31213 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5455
Mailing Address - Country:US
Mailing Address - Phone:248-723-4444
Mailing Address - Fax:248-723-3910
Practice Address - Street 1:31213 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-5455
Practice Address - Country:US
Practice Address - Phone:248-723-4444
Practice Address - Fax:248-723-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-03
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy