Provider Demographics
NPI:1386201424
Name:RX MART PHARMACY LLC
Entity Type:Organization
Organization Name:RX MART PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOUSSEF
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:AYACHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-554-5444
Mailing Address - Street 1:43171 DALCOMA DR STE #2
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038
Mailing Address - Country:US
Mailing Address - Phone:586-231-0477
Mailing Address - Fax:586-221-1894
Practice Address - Street 1:43171 DALCOMA DR STE #2
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038
Practice Address - Country:US
Practice Address - Phone:586-231-0477
Practice Address - Fax:586-221-1894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy