Provider Demographics
NPI:1215406624
Name:FRASER RX PHARMACY LLC
Entity Type:Organization
Organization Name:FRASER RX PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-MOUSSAWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-533-3542
Mailing Address - Street 1:16861 E 14 MILE RD.
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026
Mailing Address - Country:US
Mailing Address - Phone:586-217-5217
Mailing Address - Fax:586-217-5236
Practice Address - Street 1:16861 E 14 MILE RD.
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026
Practice Address - Country:US
Practice Address - Phone:586-217-5217
Practice Address - Fax:586-217-5236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy