Provider Demographics
NPI:1659583045
Name:ROMULUS CITY PHARMACY INC
Entity Type:Organization
Organization Name:ROMULUS CITY PHARMACY INC
Other - Org Name:CHERRY HILL PHARMACY #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACKLIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHOURIYEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-274-5990
Mailing Address - Street 1:23100 CHERRY HILL ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1493
Mailing Address - Country:US
Mailing Address - Phone:313-274-5990
Mailing Address - Fax:313-274-1479
Practice Address - Street 1:23100 CHERRY HILL ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1493
Practice Address - Country:US
Practice Address - Phone:313-274-5990
Practice Address - Fax:313-274-1479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301005869333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2930008Medicaid
2042237OtherPK
MIBC3612808OtherDEA
MI1144810004Medicare NSC
MI2351384OtherNCPDP