Provider Demographics
NPI:1386401685
Name:AMITY HUB LLC
Entity type:Organization
Organization Name:AMITY HUB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIWA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:414-204-4025
Mailing Address - Street 1:136 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1606
Mailing Address - Country:US
Mailing Address - Phone:414-204-4025
Mailing Address - Fax:262-429-9428
Practice Address - Street 1:245 AMITY RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2258
Practice Address - Country:US
Practice Address - Phone:203-638-4543
Practice Address - Fax:262-429-9428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy