123 Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5315038557 Issued in MI

Legal business name

123 PHARMACY LLC

Practice address

24142 W Warren St
Ste A2
Dearborn Heights, MI 48127-2256

Phone

(313) 730-0677

Fax

(313) 730-0670

NPI assigned

Nov 11, 2008

Organization subpart

No

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

Authorized official

Name

Mustapha HusseinNPI 1841019940

Title

President

Phone

(313) 645-7544

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• 123 Pharmacy LLC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mustapha Hussein

  • Pharmacist
  • Chula Vista, CA
  • NPI 1841019940
  NPD Authorized official

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

{
    "created_epoch": "1226361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304294400000",
    "number": "1376797746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24142 W WARREN ST",
            "address_2": "STE A2",
            "city": "DEARBORN HEIGHTS",
            "state": "MI",
            "postal_code": "481272256",
            "telephone_number": "313-730-0677",
            "fax_number": "313-730-0670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24142 W WARREN ST",
            "address_2": "STE A2",
            "city": "DEARBORN HEIGHTS",
            "state": "MI",
            "postal_code": "481272256",
            "telephone_number": "313-730-0677",
            "fax_number": "313-730-0670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "123 PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-11",
        "last_updated": "2011-05-02",
        "status": "A",
        "authorized_official_last_name": "HUSSEIN",
        "authorized_official_first_name": "MUSTAPHA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-645-7544"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5315038557",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2371867",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "123 Pharmacy LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Dearborn Heights, MI
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.