Provider Demographics
NPI:1659822476
Name:PHARMCARE PHARMACY LLC
Entity Type:Organization
Organization Name:PHARMCARE PHARMACY LLC
Other - Org Name:PHARMCARE PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-377-3154
Mailing Address - Street 1:24100 MEADOWBROOK RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3457
Mailing Address - Country:US
Mailing Address - Phone:734-377-3154
Mailing Address - Fax:734-345-3525
Practice Address - Street 1:24100 MEADOWBROOK RD
Practice Address - Street 2:SUITE C
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-3457
Practice Address - Country:US
Practice Address - Phone:734-377-3154
Practice Address - Fax:734-345-3525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301010992333600000X
3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166323OtherPK
MI5301010992OtherMICHIGAN BOARD OF PHARMACY LICENSE