Provider Demographics
NPI:1265687883
Name:WAYNE COUNTY JAIL PHARMACY
Entity Type:Organization
Organization Name:WAYNE COUNTY JAIL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:GAWRYK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-224-7912
Mailing Address - Street 1:570 CLINTON ST
Mailing Address - Street 2:JAIL MEDICAL
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-2334
Mailing Address - Country:US
Mailing Address - Phone:313-224-7912
Mailing Address - Fax:313-224-0768
Practice Address - Street 1:570 CLINTON ST
Practice Address - Street 2:JAIL MEDICAL
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-2334
Practice Address - Country:US
Practice Address - Phone:313-224-7912
Practice Address - Fax:313-224-0768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301003163261QP2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health