1538466545 NPI number — MONROE FAMILY PHARMACY INC

Table of content: (NPI 1538466545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538466545 NPI number — MONROE FAMILY PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONROE FAMILY PHARMACY 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:
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:
1538466545
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6907 BARRIE 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:
48126-1773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-523-5334
Provider Business Mailing Address Fax Number:
313-441-3700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14750 LAPLAISANCE RD
Provider Second Line Business Practice Location Address:
STE 270
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48161-3899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-441-6666
Provider Business Practice Location Address Fax Number:
313-441-3700
Provider Enumeration Date:
02/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ABUEIDA
Authorized Official First Name:
AIMAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
313-441-6666

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; 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: 2375170 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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