Provider Demographics
NPI:1699259390
Name:DANA PHARMACY LTC LLC
Entity type:Organization
Organization Name:DANA PHARMACY LTC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HABIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-513-4405
Mailing Address - Street 1:32440 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3204
Mailing Address - Country:US
Mailing Address - Phone:248-513-4405
Mailing Address - Fax:248-513-4723
Practice Address - Street 1:32440 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3204
Practice Address - Country:US
Practice Address - Phone:248-513-4405
Practice Address - Fax:248-513-4723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy