Provider Demographics
NPI:1437267804
Name:FARMINGTON MEDICAL PHARMACY INC
Entity Type:Organization
Organization Name:FARMINGTON MEDICAL PHARMACY INC
Other - Org Name:NIDHAL'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:G
Authorized Official - Last Name:SADEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-477-2131
Mailing Address - Street 1:23800 ORCHARD LAKE RD
Mailing Address - Street 2:STE 102
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2561
Mailing Address - Country:US
Mailing Address - Phone:248-477-2131
Mailing Address - Fax:248-477-3390
Practice Address - Street 1:23800 ORCHARD LAKE RD
Practice Address - Street 2:STE 102
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2561
Practice Address - Country:US
Practice Address - Phone:248-477-2131
Practice Address - Fax:248-477-3390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010063933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2355522Medicaid
2355522OtherOTHER ID NUMBER
MI2355522Medicaid
1314500001Medicare NSC