Premium Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PREMIUM PHARMACY LLC

Practice address

3808 Monroe St
Dearborn, MI 48124-3620

Phone

(313) 209-3339

Fax

(313) 586-9522

NPI assigned

May 27, 2014

Last updated

Nov 7, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Wafaa Dakhlallah Hakim, PHARM DNPI 1245996404

Title

Pharmacist

Phone

(313) 209-3339

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Wafaa Hakim

  • Pharmacist
  • Dearborn, MI
  • NPI 1245996404
  NPD Authorized official

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

{
    "created_epoch": "1401148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415318400000",
    "number": "1669884524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3808 MONROE ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481243620",
            "telephone_number": "313-768-8494",
            "fax_number": "313-586-9522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3808 MONROE ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481243620",
            "telephone_number": "313-209-3339",
            "fax_number": "313-586-9522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-27",
        "last_updated": "2014-11-07",
        "status": "A",
        "authorized_official_last_name": "HAKIM",
        "authorized_official_first_name": "WAFAA",
        "authorized_official_middle_name": "DAKHLALLAH",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "313-209-3339",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Retail Pharmacy in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2014; 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.