Provider Demographics
NPI:1407223803
Name:MIDTOWN RX PHARMACY INC
Entity Type:Organization
Organization Name:MIDTOWN RX PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:SROUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-832-5900
Mailing Address - Street 1:4100 WOODWARD AVE
Mailing Address - Street 2:SUITE PHARMACY
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2173
Mailing Address - Country:US
Mailing Address - Phone:313-832-5900
Mailing Address - Fax:313-832-5901
Practice Address - Street 1:4100 WOODWARD AVE
Practice Address - Street 2:SUITE PHARMACY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2173
Practice Address - Country:US
Practice Address - Phone:313-832-5900
Practice Address - Fax:313-832-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010107303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy