Provider Demographics
NPI:1578962395
Name:PAR WICK PHARMACY LLC
Entity Type:Organization
Organization Name:PAR WICK PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:JAMIL
Authorized Official - Last Name:FAKIH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-292-3750
Mailing Address - Street 1:22350 WICK RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3607
Mailing Address - Country:US
Mailing Address - Phone:313-292-3750
Mailing Address - Fax:313-292-4933
Practice Address - Street 1:22350 WICK RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3607
Practice Address - Country:US
Practice Address - Phone:313-292-3750
Practice Address - Fax:313-292-4933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010105183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315067438OtherSTATE CONTROLLED SUBSTANCE PHARMACY LICENSE
MI5301010518OtherSTATE PHARMACY LICENSE
MI5301010518OtherSTATE PHARMACY LICENSE
MI5301010518OtherSTATE PHARMACY LICENSE