Provider Demographics
NPI:1437457728
Name:MED EXPRESS INC
Entity Type:Organization
Organization Name:MED EXPRESS INC
Other - Org Name:HEARTLAND DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER/AUTHORIZED OFFICIA
Authorized Official - Prefix:
Authorized Official - First Name:YASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAISARI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM-BS
Authorized Official - Phone:313-404-5405
Mailing Address - Street 1:3800 GREENFIELD RD
Mailing Address - Street 2:PO BOX 1345
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1206
Mailing Address - Country:US
Mailing Address - Phone:586-228-1551
Mailing Address - Fax:586-228-1552
Practice Address - Street 1:43614 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1120
Practice Address - Country:US
Practice Address - Phone:586-228-1551
Practice Address - Fax:586-228-1552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
MI53010095743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2129481OtherPK