Provider Demographics
NPI:1073099701
Name:FORT ST RX PHARMACY LLC
Entity Type:Organization
Organization Name:FORT ST RX PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOBHI
Authorized Official - Middle Name:MIKE
Authorized Official - Last Name:NEME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-702-0066
Mailing Address - Street 1:2017 FORT ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-2402
Mailing Address - Country:US
Mailing Address - Phone:313-702-0066
Mailing Address - Fax:
Practice Address - Street 1:2017 FORT ST
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2402
Practice Address - Country:US
Practice Address - Phone:313-702-0066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010114163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy