Provider Demographics
NPI:1558488924
Name:THE PHARMACY INC
Entity Type:Organization
Organization Name:THE PHARMACY INC
Other - Org Name:THE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OPER
Authorized Official - Prefix:
Authorized Official - First Name:EIHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:SWIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-657-9769
Mailing Address - Street 1:5204 JACKSON RD STE C
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-1866
Mailing Address - Country:US
Mailing Address - Phone:734-821-8000
Mailing Address - Fax:734-821-8001
Practice Address - Street 1:1549 HOLMES RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-4147
Practice Address - Country:US
Practice Address - Phone:734-547-9100
Practice Address - Fax:734-547-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010085963336C0003X
3336C0004X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2369519OtherNCPDP PROVIDER IDENTIFICATION NUMBER