Provider Demographics
NPI:1174965537
Name:ELLA PHARMACY LLC
Entity type:Organization
Organization Name:ELLA PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JINAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARKOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-722-0440
Mailing Address - Street 1:42645 GARFIELD RD
Mailing Address - Street 2:STE 102
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5022
Mailing Address - Country:US
Mailing Address - Phone:586-416-1100
Mailing Address - Fax:586-416-1101
Practice Address - Street 1:42645 GARFIELD RD
Practice Address - Street 2:STE 102
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5022
Practice Address - Country:US
Practice Address - Phone:586-416-1100
Practice Address - Fax:586-416-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010101423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141444OtherPK