Provider Demographics
NPI:1629422498
Name:UNITED SPECIALTY PHARMACY LLC
Entity Type:Organization
Organization Name:UNITED SPECIALTY PHARMACY LLC
Other - Org Name:UNITED SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BILAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAABAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-558-9448
Mailing Address - Street 1:25205 TROWBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2414
Mailing Address - Country:US
Mailing Address - Phone:313-558-9448
Mailing Address - Fax:313-558-9451
Practice Address - Street 1:25205 TROWBRIDGE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2414
Practice Address - Country:US
Practice Address - Phone:313-558-9448
Practice Address - Fax:313-558-9451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010109213336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159672OtherPK