Provider Demographics
NPI:1568099281
Name:MY PHARMACY
Entity Type:Organization
Organization Name:MY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARES
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULMALEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-674-5968
Mailing Address - Street 1:2765 ROULO ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1544
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 MONROE ST STE 4
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3058
Practice Address - Country:US
Practice Address - Phone:313-674-5968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-24
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy