Provider Demographics
NPI:1548428485
Name:EXCLUSIVE FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:EXCLUSIVE FAMILY PHARMACY LLC
Other - Org Name:EXCLUSIVE FAMILY PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AIMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAWAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-336-2733
Mailing Address - Street 1:PO BOX 5157
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-0157
Mailing Address - Country:US
Mailing Address - Phone:248-336-2733
Mailing Address - Fax:248-336-2729
Practice Address - Street 1:911 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1934
Practice Address - Country:US
Practice Address - Phone:248-336-2733
Practice Address - Fax:248-336-2729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010088713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2371223OtherNCPDP PROVIDER IDENTIFICATION NUMBER