Provider Demographics
NPI:1285784520
Name:MILLENNIUM TOO PHARMACY
Entity type:Organization
Organization Name:MILLENNIUM TOO PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MUSTAPHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-495-3800
Mailing Address - Street 1:49650 CHERRY HILL RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4849
Mailing Address - Country:US
Mailing Address - Phone:734-495-3800
Mailing Address - Fax:734-495-9148
Practice Address - Street 1:49650 CHERRY HILL RD
Practice Address - Street 2:SUITE 140
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-4849
Practice Address - Country:US
Practice Address - Phone:734-495-3800
Practice Address - Fax:734-495-9148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010079413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4690608Medicaid
MI4690608Medicaid