Provider Demographics
NPI:1871963132
Name:NOVI DISCOUNT PHARMACY LLC
Entity type:Organization
Organization Name:NOVI DISCOUNT PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:HUSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEAITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-926-1212
Mailing Address - Street 1:45021 W PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1255
Mailing Address - Country:US
Mailing Address - Phone:248-926-1212
Mailing Address - Fax:844-270-5396
Practice Address - Street 1:45021 W PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-1255
Practice Address - Country:US
Practice Address - Phone:313-427-8116
Practice Address - Fax:844-270-5396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301010735333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152232OtherPK