1902264484 NPI number — ULTIMATE CARE PHARMACY

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 1902264484 NPI number — ULTIMATE CARE PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ULTIMATE CARE PHARMACY
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:
Provider Other Organization Name Type Code:
6
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:
1902264484
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5271 TERNES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEARBORN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48126-4625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-516-5006
Provider Business Mailing Address Fax Number:
248-206-7619

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15075 LINCOLN ST
Provider Second Line Business Practice Location Address:
110
Provider Business Practice Location Address City Name:
OAK PARK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48237-3335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-206-7603
Provider Business Practice Location Address Fax Number:
248-206-7619
Provider Enumeration Date:
01/29/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SABBAGH
Authorized Official First Name:
HUSSEIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
313-516-5006

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  5301010694 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2157695 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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