1417327966 NPI number — LAHSER MEDICAL CENTER PHARMACY LLC

Table of content: PAUL LENIN GOTTLIEB M.D (NPI 1619937463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417327966 NPI number — LAHSER MEDICAL CENTER PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAHSER MEDICAL CENTER PHARMACY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAHSER MEDICAL CAMPUS PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417327966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27207 LAHSER RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48034-2168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-262-7679
Provider Business Mailing Address Fax Number:
248-262-7973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27207 LAHSER RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48034-2168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-262-7679
Provider Business Practice Location Address Fax Number:
248-262-7973
Provider Enumeration Date:
09/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BEYDOUN
Authorized Official First Name:
HADY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PIC/AO
Authorized Official Telephone Number:
313-844-7447

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 5301010804 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2155596 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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