Provider Demographics
NPI:1316369176
Name:SCHAEFER MEDICAL PHARMACY INC
Entity Type:Organization
Organization Name:SCHAEFER MEDICAL PHARMACY INC
Other - Org Name:SCHAEFER MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASSIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-749-7967
Mailing Address - Street 1:7738 SCHAEFER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1159
Mailing Address - Country:US
Mailing Address - Phone:313-749-7967
Mailing Address - Fax:313-749-7962
Practice Address - Street 1:7738 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1159
Practice Address - Country:US
Practice Address - Phone:313-749-7967
Practice Address - Fax:313-749-7962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010103163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143885OtherPK