1922058239 NPI number — 5412 WEST WARREN DRUGS INC.

Table of content: (NPI 1922058239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922058239 NPI number — 5412 WEST WARREN DRUGS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
5412 WEST WARREN DRUGS INC.
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:
ACTION DRUGS #2
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:
1922058239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5412 W WARREN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48210-1217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-894-4300
Provider Business Mailing Address Fax Number:
313-894-7170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5412 W WARREN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48210-1217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-894-4300
Provider Business Practice Location Address Fax Number:
313-894-7170
Provider Enumeration Date:
05/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TUBBEN
Authorized Official First Name:
NEIL
Authorized Official Middle Name:
FRANKLIN
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
313-894-4300

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  5301004336 , 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: 2340040 . This is a "NABP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".