Provider Demographics
NPI:1679645469
Name:CUSTOMCARE PHARMACY INC
Entity Type:Organization
Organization Name:CUSTOMCARE PHARMACY INC
Other - Org Name:CUSTOMCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAWAIDEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-551-8290
Mailing Address - Street 1:3535 W 13 MILE RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6770
Mailing Address - Country:US
Mailing Address - Phone:248-551-8290
Mailing Address - Fax:248-551-8253
Practice Address - Street 1:3535 W 13 MILE RD
Practice Address - Street 2:SUITE 124
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6770
Practice Address - Country:US
Practice Address - Phone:248-551-8290
Practice Address - Fax:248-551-8253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010094413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127657OtherPK