Provider Demographics
NPI:1790258069
Name:MED-X PHARMACY PC
Entity Type:Organization
Organization Name:MED-X PHARMACY PC
Other - Org Name:MED-X PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC/AO
Authorized Official - Prefix:
Authorized Official - First Name:FARES
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALMUJAHID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-859-5866
Mailing Address - Street 1:PO BOX 684
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48121-0684
Mailing Address - Country:US
Mailing Address - Phone:586-859-5866
Mailing Address - Fax:586-859-5867
Practice Address - Street 1:14993 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2147
Practice Address - Country:US
Practice Address - Phone:586-859-5866
Practice Address - Fax:586-859-5867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-09
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy