Provider Demographics
NPI:1669855136
Name:EXTRA CARE PHARMACY INC.
Entity Type:Organization
Organization Name:EXTRA CARE PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WISSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-320-6003
Mailing Address - Street 1:22341 W 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-1217
Mailing Address - Country:US
Mailing Address - Phone:313-387-1700
Mailing Address - Fax:313-387-1704
Practice Address - Street 1:22341 W 8 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-1217
Practice Address - Country:US
Practice Address - Phone:313-387-1700
Practice Address - Fax:313-387-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010107033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy