Provider Demographics
NPI:1346887866
Name:COMMUNITY CARE RX LLC
Entity Type:Organization
Organization Name:COMMUNITY CARE RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAISA
Authorized Official - Middle Name:JAMIE
Authorized Official - Last Name:HIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-889-8909
Mailing Address - Street 1:6659 SCHAEFER RD STE 117
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1812
Mailing Address - Country:US
Mailing Address - Phone:313-889-8909
Mailing Address - Fax:
Practice Address - Street 1:29484 FORD RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2318
Practice Address - Country:US
Practice Address - Phone:313-889-8909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-03
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5301013030OtherSTATE LICENSE