Provider Demographics
NPI:1184260838
Name:DABAJA RX LLC
Entity type:Organization
Organization Name:DABAJA RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/R.PH.
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:K
Authorized Official - Last Name:DABAJA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:248-569-0450
Mailing Address - Street 1:20905 GREENFIELD RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5344
Mailing Address - Country:US
Mailing Address - Phone:248-569-0450
Mailing Address - Fax:248-569-5512
Practice Address - Street 1:20905 GREENFIELD RD STE 104
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5344
Practice Address - Country:US
Practice Address - Phone:248-569-0450
Practice Address - Fax:248-569-5512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy