Provider Demographics
NPI:1588487748
Name:VALLEY MEDICAL PHARMACY LLC
Entity type:Organization
Organization Name:VALLEY MEDICAL PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOU-TAAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:734-729-2882
Mailing Address - Street 1:4020 VENOY RD STE 900A
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-1869
Mailing Address - Country:US
Mailing Address - Phone:734-729-2882
Mailing Address - Fax:734-729-6546
Practice Address - Street 1:4020 VENOY RD STE 900A
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1869
Practice Address - Country:US
Practice Address - Phone:734-729-2882
Practice Address - Fax:734-729-6546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy