Provider Demographics
NPI:1578690186
Name:SPRINGWELLS CLINICAL PHARMACY INC
Entity Type:Organization
Organization Name:SPRINGWELLS CLINICAL PHARMACY INC
Other - Org Name:SOUTHWEST DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAKHLALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-841-9350
Mailing Address - Street 1:5851 W VERNOR HWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-2159
Mailing Address - Country:US
Mailing Address - Phone:313-841-9350
Mailing Address - Fax:313-841-9377
Practice Address - Street 1:5851 W VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-2159
Practice Address - Country:US
Practice Address - Phone:313-841-9350
Practice Address - Fax:313-841-9377
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPRINGWELLS CLINICAL PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-28
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301008142333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MINCPDPOther2367173
MI5444460007Medicare NSC