1871641878 NPI number — ALLEGAN PHARMACY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871641878 NPI number — ALLEGAN PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLEGAN 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:
ALLEGAN MEDICAL CENTER 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:
1871641878
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
551 LINN ST
Provider Second Line Business Mailing Address:
STE120
Provider Business Mailing Address City Name:
ALLEGAN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-673-4700
Provider Business Mailing Address Fax Number:
269-673-4711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
551 LINN ST
Provider Second Line Business Practice Location Address:
STE120
Provider Business Practice Location Address City Name:
ALLEGAN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-673-4700
Provider Business Practice Location Address Fax Number:
269-673-4711
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BEYDOUN
Authorized Official First Name:
MOHAMED
Authorized Official Middle Name:
ALI
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
313-378-1938

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  5301008560 , 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: 2042556 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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