Provider Demographics
NPI:1588170823
Name:ELWASEEM-TOOR LLC
Entity type:Organization
Organization Name:ELWASEEM-TOOR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:ZEESHAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:TOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-879-0997
Mailing Address - Street 1:16970 E 13 MILE RD STE A
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-7719
Mailing Address - Country:US
Mailing Address - Phone:586-879-0997
Mailing Address - Fax:586-879-0967
Practice Address - Street 1:16970 E 13 MILE RD STE A
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-7719
Practice Address - Country:US
Practice Address - Phone:586-879-0997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-22
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
MI53010113073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy