Provider Demographics
NPI:1639620750
Name:CITIZENS PHARMACY INC
Entity Type:Organization
Organization Name:CITIZENS PHARMACY INC
Other - Org Name:CITIZENS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NADA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOUDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-804-9377
Mailing Address - Street 1:15537 SCHOOLCRAFT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1755
Mailing Address - Country:US
Mailing Address - Phone:313-770-7771
Mailing Address - Fax:
Practice Address - Street 1:15537 SCHOOLCRAFT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-1755
Practice Address - Country:US
Practice Address - Phone:313-770-7771
Practice Address - Fax:313-744-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010110283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164515OtherPK