Provider Demographics
NPI:1972741262
Name:LEVAN MEDICAL PHARMACY LLC
Entity Type:Organization
Organization Name:LEVAN MEDICAL PHARMACY LLC
Other - Org Name:LEVAN MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MUSTAPHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:734-462-8005
Mailing Address - Street 1:15132 LEVAN RD
Mailing Address - Street 2:STE 32
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5027
Mailing Address - Country:US
Mailing Address - Phone:734-462-8005
Mailing Address - Fax:734-462-8009
Practice Address - Street 1:15132 LEVAN RD
Practice Address - Street 2:STE 32
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5027
Practice Address - Country:US
Practice Address - Phone:734-462-8005
Practice Address - Fax:734-462-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010090503336C0003X
3336C0004X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2372376OtherNCPDP PROVIDER IDENTIFICATION NUMBER