Provider Demographics
NPI:1912270489
Name:DEARBORN FAMILY PHARMACY
Entity Type:Organization
Organization Name:DEARBORN FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:AIMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUEIDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-523-5334
Mailing Address - Street 1:17000 EXECUTIVE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2610
Mailing Address - Country:US
Mailing Address - Phone:313-523-5334
Mailing Address - Fax:313-441-3700
Practice Address - Street 1:17000 EXECUTIVE PLAZA DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2610
Practice Address - Country:US
Practice Address - Phone:313-523-5334
Practice Address - Fax:313-441-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy