Provider Demographics
NPI:1487269122
Name:CANFIELD PHARMACY LLC
Entity type:Organization
Organization Name:CANFIELD PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARIS
Authorized Official - Middle Name:MAZEN
Authorized Official - Last Name:GAMMOH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:313-458-7529
Mailing Address - Street 1:4673 CONNER ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-2028
Mailing Address - Country:US
Mailing Address - Phone:313-458-7529
Mailing Address - Fax:313-458-7547
Practice Address - Street 1:4673 CONNER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2028
Practice Address - Country:US
Practice Address - Phone:313-458-7529
Practice Address - Fax:313-458-7547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy