Provider Demographics
NPI:1972985943
Name:PALM PHARMACY
Entity Type:Organization
Organization Name:PALM PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:EL KHATIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-485-9722
Mailing Address - Street 1:6650 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1701
Mailing Address - Country:US
Mailing Address - Phone:313-436-0156
Mailing Address - Fax:313-436-0153
Practice Address - Street 1:6650 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1701
Practice Address - Country:US
Practice Address - Phone:313-436-0156
Practice Address - Fax:313-436-0153
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEHDINA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-25
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010106853336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy