1255874384 NPI number — HADY ENTERPRISES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255874384 NPI number — HADY ENTERPRISES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HADY ENTERPRISES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTER ROAD PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255874384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1513 S CENTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48509-1728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-309-3209
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1513 S CENTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48509-1728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-309-3209
Provider Business Practice Location Address Fax Number:
810-221-7356
Provider Enumeration Date:
11/21/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ALOUH
Authorized Official First Name:
AHMAD KAML
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
810-728-5048

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 5301011058 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1255874384 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2166462 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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