Provider Demographics
NPI:1982930954
Name:SAV-MAX PHARMACY-MAZEN LLC
Entity type:Organization
Organization Name:SAV-MAX PHARMACY-MAZEN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISMAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUHANIEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-371-3300
Mailing Address - Street 1:12740 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-3944
Mailing Address - Country:US
Mailing Address - Phone:313-371-3300
Mailing Address - Fax:313-371-3344
Practice Address - Street 1:12740 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-3944
Practice Address - Country:US
Practice Address - Phone:313-371-3300
Practice Address - Fax:313-371-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010092023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122399OtherPK