Provider Demographics
NPI:1053501395
Name:AMERICAN MAIL ORDER PHARMACY INC
Entity Type:Organization
Organization Name:AMERICAN MAIL ORDER PHARMACY INC
Other - Org Name:AMOP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT,PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AWADA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:586-772-6872
Mailing Address - Street 1:23290 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-4260
Mailing Address - Country:US
Mailing Address - Phone:586-772-6872
Mailing Address - Fax:586-772-6873
Practice Address - Street 1:23290 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-4260
Practice Address - Country:US
Practice Address - Phone:586-772-6872
Practice Address - Fax:586-772-6873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010085983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2370269Medicaid
2042763OtherPK