Provider Demographics
NPI:1568891703
Name:CHASE HEALTH PHARMACY PC
Entity Type:Organization
Organization Name:CHASE HEALTH PHARMACY PC
Other - Org Name:CHASE HEALTH PHARMACY PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ABIR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUKR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-673-6565
Mailing Address - Street 1:6200 CHASE RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2108
Mailing Address - Country:US
Mailing Address - Phone:313-769-6817
Mailing Address - Fax:313-769-6814
Practice Address - Street 1:6200 CHASE RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2108
Practice Address - Country:US
Practice Address - Phone:313-769-6817
Practice Address - Fax:313-769-6814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010102323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2139654OtherPK