Provider Demographics
NPI:1417203399
Name:MERCURY DRUGS LLC
Entity Type:Organization
Organization Name:MERCURY DRUGS LLC
Other - Org Name:MERCURY DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:YASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:248-545-3600
Mailing Address - Street 1:22150 COOLIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2813
Mailing Address - Country:US
Mailing Address - Phone:248-545-3600
Mailing Address - Fax:248-545-3601
Practice Address - Street 1:22150 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2813
Practice Address - Country:US
Practice Address - Phone:248-545-3600
Practice Address - Fax:248-545-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010098723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136276OtherPK