Provider Demographics
NPI:1598032948
Name:MED DRUG PHARMACY INC
Entity Type:Organization
Organization Name:MED DRUG PHARMACY INC
Other - Org Name:MED DRUG PHARMACY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSAMARAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-835-9999
Mailing Address - Street 1:26206 W 12 MILE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1799
Mailing Address - Country:US
Mailing Address - Phone:248-351-0943
Mailing Address - Fax:
Practice Address - Street 1:26206 W 12 MILE RD STE 108
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1799
Practice Address - Country:US
Practice Address - Phone:248-262-7740
Practice Address - Fax:248-262-7741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010097573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2376108OtherNCPDP PROVIDER IDENTIFICATION NUMBER