Provider Demographics
NPI:1548093016
Name:NINE MILE RX, LLC.
Entity type:Organization
Organization Name:NINE MILE RX, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:KASSEM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHRAIZAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-622-4711
Mailing Address - Street 1:717 E 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1986
Mailing Address - Country:US
Mailing Address - Phone:313-622-4711
Mailing Address - Fax:
Practice Address - Street 1:717 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1986
Practice Address - Country:US
Practice Address - Phone:313-622-4711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy