Premier Home Pharmacy of Mi

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301010075 Issued in MI

Legal business name

PREMIER HOME PHARMACY OF MI

Doing business as

Premier Home Pharmacy of MI

Practice address

23874 Kean St
Suite 120
Dearborn, MI 48124-1804

Phone

(313) 887-9111

Fax

(313) 887-4229

NPI assigned

Oct 13, 2012

Organization subpart

No

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

Authorized official

Name

Syed Raza

Title

Owner

Phone

(734) 658-8985

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Premier Home Pharmacy of MI Doing business as

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

{
    "created_epoch": "1350086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456876800000",
    "number": "1831441971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23874 KEAN ST",
            "address_2": "SUITE 120",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241804",
            "telephone_number": "313-887-9111",
            "fax_number": "313-887-4229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23874 KEAN ST",
            "address_2": "SUITE 120",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241804",
            "telephone_number": "313-887-9111",
            "fax_number": "313-887-4229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER HOME PHARMACY OF MI",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-13",
        "last_updated": "2016-03-02",
        "status": "A",
        "authorized_official_last_name": "RAZA",
        "authorized_official_first_name": "SYED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-658-8985"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301010075",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831441971",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2137422",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Home Pharmacy of MI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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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 Mar 2, 2016; 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.