Provider Demographics
NPI:1669884524
Name:PREMIUM PHARMACY LLC
Entity type:Organization
Organization Name:PREMIUM PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WAFAA
Authorized Official - Middle Name:DAKHLALLAH
Authorized Official - Last Name:HAKIM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:313-209-3339
Mailing Address - Street 1:3808 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3620
Mailing Address - Country:US
Mailing Address - Phone:313-768-8494
Mailing Address - Fax:313-586-9522
Practice Address - Street 1:3808 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3620
Practice Address - Country:US
Practice Address - Phone:313-209-3339
Practice Address - Fax:313-586-9522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy