Provider Demographics
NPI:1730489022
Name:ORCHARD PHARMACY CENTER INC
Entity Type:Organization
Organization Name:ORCHARD PHARMACY CENTER INC
Other - Org Name:SUMPTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:K
Authorized Official - Last Name:NASSER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-485-1411
Mailing Address - Street 1:19731 SUMPTER RD.
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-8919
Mailing Address - Country:US
Mailing Address - Phone:734-391-8284
Mailing Address - Fax:734-391-8231
Practice Address - Street 1:19731 SUMPTER RD.
Practice Address - Street 2:19731 SUMPTER RD
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-8919
Practice Address - Country:US
Practice Address - Phone:734-391-8284
Practice Address - Fax:734-391-8231
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORCHARD PHARMACY CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-02
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53150485593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy