Provider Demographics
NPI:1609255793
Name:CHASE MEDICAL PHARMACY LLC
Entity Type:Organization
Organization Name:CHASE MEDICAL PHARMACY LLC
Other - Org Name:CHASE MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:RANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABAZEED
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-791-7390
Mailing Address - Street 1:5901 CHASE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2103
Mailing Address - Country:US
Mailing Address - Phone:313-791-7390
Mailing Address - Fax:313-791-7937
Practice Address - Street 1:5901 CHASE RD STE 100
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2103
Practice Address - Country:US
Practice Address - Phone:313-791-7390
Practice Address - Fax:313-791-7937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010106633336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1609255793Medicaid
2151640OtherPK