Provider Demographics
NPI:1992367767
Name:METRO FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:METRO FAMILY PHARMACY LLC
Other - Org Name:METRO FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JANAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HANI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:313-733-6346
Mailing Address - Street 1:3260 W DAVISON AV
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238
Mailing Address - Country:US
Mailing Address - Phone:313-733-6346
Mailing Address - Fax:313-826-7413
Practice Address - Street 1:3260 W DAVISON AV
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238
Practice Address - Country:US
Practice Address - Phone:313-733-6346
Practice Address - Fax:313-826-7413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1992367767Medicaid