1881878486 NPI number — FORD CAMPUS PHARMACY LLC

Table of content: (NPI 1881878486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881878486 NPI number — FORD CAMPUS PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORD CAMPUS PHARMACY LLC
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:
PHARMOR PHARMACY - FORD CAMPUS 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:
1881878486
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2699 W GRAND BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48208-1233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-875-9000
Provider Business Mailing Address Fax Number:
313-875-9099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2699 W GRAND BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48208-1233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-875-9000
Provider Business Practice Location Address Fax Number:
313-875-9099
Provider Enumeration Date:
12/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SAID
Authorized Official First Name:
AHMED
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
313-377-8876

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: 5301008762 , 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: 2043559 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1881878486 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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