Provider Demographics
NPI:1265869309
Name:MYA PHARMACY LLC
Entity type:Organization
Organization Name:MYA PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONA
Authorized Official - Middle Name:YOUSSEF
Authorized Official - Last Name:FAKIH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-218-4140
Mailing Address - Street 1:25308 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124
Mailing Address - Country:US
Mailing Address - Phone:313-218-4140
Mailing Address - Fax:
Practice Address - Street 1:25150 FORD ROAD
Practice Address - Street 2:SUITE 120
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3115
Practice Address - Country:US
Practice Address - Phone:313-277-4044
Practice Address - Fax:313-277-4045
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONA FAKIH DO PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy