Active NPI
Dena Jadallah
- Community/Retail Pharmacy
- Dearborn Heights, MI
National Provider Identifier
1487242806
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 5302413156
- Practice address
- 5709 S Telegraph Rd
Dearborn Heights, MI 48125-2025 - Phone
- (313) 292-1599
- NPI assigned
- Jan 3, 2021
- Last updated
- Jan 6, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 5302413156 | MI | Primary |
Addresses
Primary practice location
5709 S Telegraph Rd
Dearborn Heights, MI 48125-2025
Mailing address
20054 Dovetail Dr
Brownstown TWP, MI 48183-1182
Phone (313) 523-1990
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302413156 | MI | MD | Community/Retail Pharmacy |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Community/Retail Pharmacy | Current | Accepting new patients |
| Walgreen Co | Community/Retail Pharmacy | Past | Accepting new patients |
Locations
5709 S Telegraph Rd
Dearborn Hts, MI 48125
Phone (313) 292-1599
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609891200000",
"number": "1487242806",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20054 DOVETAIL DR",
"city": "BROWNSTOWN TWP",
"state": "MI",
"postal_code": "481831182",
"telephone_number": "313-523-1990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5709 S TELEGRAPH RD",
"city": "DEARBORN HEIGHTS",
"state": "MI",
"postal_code": "481252025",
"telephone_number": "313-292-1599"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JADALLAH",
"first_name": "DENA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-01-03",
"last_updated": "2021-01-06",
"certification_date": "2021-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "MI",
"license": "5302413156",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dearborn Heights, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.