Provider Demographics
NPI:1013409424
Name:NORTHWESTERN RX, P.C.
Entity Type:Organization
Organization Name:NORTHWESTERN RX, P.C.
Other - Org Name:NORTHWESTERN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ABDALLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHASHAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-802-0248
Mailing Address - Street 1:26206 W 12 MILE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1799
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26206 W 12 MILE RD STE 108
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1799
Practice Address - Country:US
Practice Address - Phone:248-996-9335
Practice Address - Fax:248-864-8965
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWESTERN RX, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-31
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy