Provider Demographics
NPI:1285460469
Name:CRESCENT VENTURES GROUP LLC
Entity type:Organization
Organization Name:CRESCENT VENTURES GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:MAHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:ELAHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-997-7633
Mailing Address - Street 1:23133 ORCHARD LAKE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3278
Mailing Address - Country:US
Mailing Address - Phone:248-997-7633
Mailing Address - Fax:248-997-7633
Practice Address - Street 1:23133 ORCHARD LAKE RD STE 101
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3278
Practice Address - Country:US
Practice Address - Phone:248-997-7633
Practice Address - Fax:248-997-7633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy