Provider Demographics
NPI:1508212366
Name:PRIME CARE PHARMACY LLC
Entity Type:Organization
Organization Name:PRIME CARE PHARMACY LLC
Other - Org Name:PRIME CARE PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, AO
Authorized Official - Prefix:
Authorized Official - First Name:RABIH
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-SIBAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-525-2425
Mailing Address - Street 1:3 HERITAGE DR # 3
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-3000
Mailing Address - Country:US
Mailing Address - Phone:734-324-1290
Mailing Address - Fax:734-324-1292
Practice Address - Street 1:3 HERITAGE DR # 3
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-3000
Practice Address - Country:US
Practice Address - Phone:734-324-1290
Practice Address - Fax:734-324-1292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010109253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160603OtherPK