Provider Demographics
NPI:1902105034
Name:NILE FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:NILE FAMILY PHARMACY LLC
Other - Org Name:NILE FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AIMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAWAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-683-1400
Mailing Address - Street 1:PO BOX 5157
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-0157
Mailing Address - Country:US
Mailing Address - Phone:269-683-1400
Mailing Address - Fax:269-683-1402
Practice Address - Street 1:70 E. STATE ST.
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120
Practice Address - Country:US
Practice Address - Phone:269-683-1400
Practice Address - Fax:269-683-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
MI53010095303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2129509OtherPK