Provider Demographics
NPI:1558585687
Name:XRX, INC
Entity Type:Organization
Organization Name:XRX, INC
Other - Org Name:STADIUM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:JAMAL
Authorized Official - Last Name:TATO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:734-913-4752
Mailing Address - Street 1:1930 W STADIUM BLVD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-4504
Mailing Address - Country:US
Mailing Address - Phone:734-913-4752
Mailing Address - Fax:734-913-9032
Practice Address - Street 1:1930 W STADIUM BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-4504
Practice Address - Country:US
Practice Address - Phone:734-913-4752
Practice Address - Fax:734-913-9032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010076923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy