Provider Demographics
NPI:1760924872
Name:INSTACARE PHARMACY LLC
Entity Type:Organization
Organization Name:INSTACARE PHARMACY LLC
Other - Org Name:INSTACARE PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RAFI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-800-1111
Mailing Address - Street 1:14300 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126
Mailing Address - Country:US
Mailing Address - Phone:313-800-1111
Mailing Address - Fax:313-855-8000
Practice Address - Street 1:14300 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3417
Practice Address - Country:US
Practice Address - Phone:313-800-1111
Practice Address - Fax:313-855-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MI53010110483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166148OtherPK