Provider Demographics
NPI:1770972788
Name:WEST DEARBORN PHARMACY LLC
Entity type:Organization
Organization Name:WEST DEARBORN PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER,PIC,AO
Authorized Official - Prefix:
Authorized Official - First Name:NABEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBADANY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:734-720-7355
Mailing Address - Street 1:14625 TELEGRAPH RD
Mailing Address - Street 2:STE B
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4637
Mailing Address - Country:US
Mailing Address - Phone:734-720-7355
Mailing Address - Fax:734-720-7454
Practice Address - Street 1:14625 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4637
Practice Address - Country:US
Practice Address - Phone:734-720-7355
Practice Address - Fax:734-720-7454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010106113336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149653OtherPK