Provider Demographics
NPI:1164533220
Name:ACCESS PHARMACY INC
Entity Type:Organization
Organization Name:ACCESS PHARMACY INC
Other - Org Name:ACCESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMZI
Authorized Official - Middle Name:
Authorized Official - Last Name:JAWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-216-2213
Mailing Address - Street 1:6450 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2259
Mailing Address - Country:US
Mailing Address - Phone:313-216-2213
Mailing Address - Fax:313-584-3249
Practice Address - Street 1:6450 MAPLE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2259
Practice Address - Country:US
Practice Address - Phone:313-216-2213
Practice Address - Fax:313-584-3249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010075253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2363668OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MI2363668Medicaid
MI2363668Medicaid