Provider Demographics
NPI:1134199979
Name:NAZIRKO LLC
Entity type:Organization
Organization Name:NAZIRKO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELNAZIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-561-9700
Mailing Address - Street 1:2040 MONROE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2950
Mailing Address - Country:US
Mailing Address - Phone:313-561-9700
Mailing Address - Fax:313-561-6903
Practice Address - Street 1:2040 MONROE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2950
Practice Address - Country:US
Practice Address - Phone:313-561-9700
Practice Address - Fax:313-561-6903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MI53010090863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2042116OtherPK
MI5634630001Medicare NSC
MI1134199979OtherNPI