Provider Demographics
NPI:1831780683
Name:LIVONIA EXPRESS PHARMACY LLC
Entity type:Organization
Organization Name:LIVONIA EXPRESS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULMALEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-674-5968
Mailing Address - Street 1:28275 FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3998
Mailing Address - Country:US
Mailing Address - Phone:734-237-4949
Mailing Address - Fax:313-406-6783
Practice Address - Street 1:28275 FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3998
Practice Address - Country:US
Practice Address - Phone:313-674-5968
Practice Address - Fax:313-406-6783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy