Provider Demographics
NPI:1326135518
Name:FAMILY DRUG PHARMACY V INC
Entity Type:Organization
Organization Name:FAMILY DRUG PHARMACY V INC
Other - Org Name:FAMILY DRUG PHARMACY V INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MERSEDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHFEGHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-531-9200
Mailing Address - Street 1:18320 HEATHERLEA DR
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4085
Mailing Address - Country:US
Mailing Address - Phone:734-469-9600
Mailing Address - Fax:
Practice Address - Street 1:25241 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-1404
Practice Address - Country:US
Practice Address - Phone:313-531-9200
Practice Address - Fax:313-531-3511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010101263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142271OtherPK