Provider Demographics
NPI:1518382860
Name:TRI-STAR PHARMACY LLC
Entity Type:Organization
Organization Name:TRI-STAR PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:
Authorized Official - Last Name:JAWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-674-9800
Mailing Address - Street 1:PO BOX 1781
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48121-1781
Mailing Address - Country:US
Mailing Address - Phone:313-674-9800
Mailing Address - Fax:313-674-9800
Practice Address - Street 1:2840 CROOKS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3676
Practice Address - Country:US
Practice Address - Phone:313-674-9800
Practice Address - Fax:313-586-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010108033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI19 GROUPOtherRETAIL PHARMACY