Provider Demographics
NPI:1538322722
Name:DESH PHARMACY LLC
Entity Type:Organization
Organization Name:DESH PHARMACY LLC
Other - Org Name:DESH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-366-3800
Mailing Address - Street 1:12170 CONANT ST
Mailing Address - Street 2:STE E
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48212-4137
Mailing Address - Country:US
Mailing Address - Phone:313-366-3800
Mailing Address - Fax:313-366-5590
Practice Address - Street 1:12170 CONANT ST
Practice Address - Street 2:STE E
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-4137
Practice Address - Country:US
Practice Address - Phone:313-366-3800
Practice Address - Fax:313-366-5590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MI53010088873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2043818OtherPK