Provider Demographics
NPI:1326331711
Name:PREMIER CARE PHARMACY INC
Entity Type:Organization
Organization Name:PREMIER CARE PHARMACY INC
Other - Org Name:PREMIER CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAED
Authorized Official - Middle Name:
Authorized Official - Last Name:SUEDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-779-4131
Mailing Address - Street 1:23131 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1360
Mailing Address - Country:US
Mailing Address - Phone:248-544-4500
Mailing Address - Fax:248-544-4585
Practice Address - Street 1:23131 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1360
Practice Address - Country:US
Practice Address - Phone:248-544-4500
Practice Address - Fax:248-544-4585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010096383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130607OtherPK