Provider Demographics
NPI:1376583021
Name:NEW MO-TOWN PHARMACY INC
Entity Type:Organization
Organization Name:NEW MO-TOWN PHARMACY INC
Other - Org Name:NEW MO-TOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:313-999-9499
Mailing Address - Street 1:20333 CONANT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-1228
Mailing Address - Country:US
Mailing Address - Phone:313-891-2253
Mailing Address - Fax:313-891-2251
Practice Address - Street 1:20333 CONANT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-1228
Practice Address - Country:US
Practice Address - Phone:313-891-2253
Practice Address - Fax:313-891-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2044863OtherPK