Provider Demographics
NPI:1790596146
Name:ADRIAN'S MAIN STREET PHARMACY LLC
Entity type:Organization
Organization Name:ADRIAN'S MAIN STREET PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:H
Authorized Official - Last Name:NAZZAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-883-0785
Mailing Address - Street 1:27901 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-2324
Mailing Address - Country:US
Mailing Address - Phone:734-883-0785
Mailing Address - Fax:
Practice Address - Street 1:61 CLAIRMOUNT ST STE 103
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1592
Practice Address - Country:US
Practice Address - Phone:313-487-9030
Practice Address - Fax:313-487-9031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy