Provider Demographics
NPI:1104397843
Name:HEALTHCENTER PHARMACY, LLC
Entity type:Organization
Organization Name:HEALTHCENTER PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAIDAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:586-421-4003
Mailing Address - Street 1:21600 HARPER AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2242
Mailing Address - Country:US
Mailing Address - Phone:586-421-4003
Mailing Address - Fax:586-421-4654
Practice Address - Street 1:21600 HARPER AVE STE 300
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2242
Practice Address - Country:US
Practice Address - Phone:586-421-4003
Practice Address - Fax:586-421-4654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5301011513OtherMICHIGAN STATE LICENSE