Provider Demographics
NPI:1144593781
Name:ACE HEALTHCARE PLLC
Entity Type:Organization
Organization Name:ACE HEALTHCARE PLLC
Other - Org Name:YOUNG PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-324-8563
Mailing Address - Street 1:79 W ALEXANDRINE ST
Mailing Address - Street 2:SUITE LL
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2015
Mailing Address - Country:US
Mailing Address - Phone:313-324-8563
Mailing Address - Fax:313-833-3874
Practice Address - Street 1:79 W ALEXANDRINE ST
Practice Address - Street 2:SUITE LL
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2015
Practice Address - Country:US
Practice Address - Phone:313-324-8563
Practice Address - Fax:313-833-3874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X
MI53010097973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2376463OtherNCPDP PROVIDER IDENTIFICATION NUMBER