Provider Demographics
NPI:1831203728
Name:ADAM LIVONIA INC
Entity type:Organization
Organization Name:ADAM LIVONIA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WANSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-231-2262
Mailing Address - Street 1:8810 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-4052
Mailing Address - Country:US
Mailing Address - Phone:734-261-4400
Mailing Address - Fax:734-261-4803
Practice Address - Street 1:8810 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-4052
Practice Address - Country:US
Practice Address - Phone:734-261-4400
Practice Address - Fax:734-261-4803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010084023336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4936548Medicaid
2368480OtherNCPDP PROVIDER IDENTIFICATION NUMBER
2368480OtherNCPDP PROVIDER IDENTIFICATION NUMBER