Provider Demographics
NPI:1457606782
Name:BIG HOUSE PHARMACY, PLLC
Entity Type:Organization
Organization Name:BIG HOUSE PHARMACY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SUFYAN
Authorized Official - Middle Name:MOSBAH
Authorized Official - Last Name:ABUNADA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MBA
Authorized Official - Phone:248-207-5416
Mailing Address - Street 1:1000 E STADIUM BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4616
Mailing Address - Country:US
Mailing Address - Phone:734-929-2425
Mailing Address - Fax:
Practice Address - Street 1:1000 E STADIUM BLVD
Practice Address - Street 2:STE B
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4616
Practice Address - Country:US
Practice Address - Phone:734-929-2425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7278550001Medicare NSC