Healthcenter Pharmacy, LLC

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

HEALTHCENTER PHARMACY, LLC

Practice address

21600 Harper Ave Ste 300
Saint Clair Shores, MI 48080-2242

Phone

(586) 421-4003

Fax

(586) 421-4654

NPI assigned

Dec 6, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mustafa M Haidar, PHARMD

Title

Pharmacist/Pic

Phone

(586) 421-4003

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• HealthCenter Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1544054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724371200000",
    "number": "1104397843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21600 HARPER AVE STE 300",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480802242",
            "telephone_number": "586-421-4003",
            "fax_number": "586-421-4654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21600 HARPER AVE STE 300",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480802242",
            "telephone_number": "586-421-4003",
            "fax_number": "586-421-4654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHCENTER PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-06",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A",
        "authorized_official_last_name": "HAIDAR",
        "authorized_official_first_name": "MUSTAFA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PHARMACIST/PIC",
        "authorized_official_telephone_number": "586-421-4003",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MICHIGAN STATE LICENSE",
            "identifier": "5301011513",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HealthCenter Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HealthCenter Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pharmacy in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.