Provider Demographics
NPI:1790135671
Name:PHARMACHOICE INC
Entity Type:Organization
Organization Name:PHARMACHOICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:
Authorized Official - Last Name:JAWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-581-6000
Mailing Address - Street 1:15635 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-3733
Mailing Address - Country:US
Mailing Address - Phone:313-581-6000
Mailing Address - Fax:313-581-6600
Practice Address - Street 1:15635 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3733
Practice Address - Country:US
Practice Address - Phone:313-581-6000
Practice Address - Fax:313-581-6600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
MI53010110403336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166041OtherPK