Provider Demographics
NPI:1790961118
Name:MADISON PHARMACY INC
Entity Type:Organization
Organization Name:MADISON PHARMACY INC
Other - Org Name:MADISON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMEER
Authorized Official - Middle Name:
Authorized Official - Last Name:SALMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-336-8900
Mailing Address - Street 1:1385 E 12 MILE RD
Mailing Address - Street 2:STE 105
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2602
Mailing Address - Country:US
Mailing Address - Phone:248-336-8900
Mailing Address - Fax:248-336-9700
Practice Address - Street 1:1385 E 12 MILE RD
Practice Address - Street 2:STE 105
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2602
Practice Address - Country:US
Practice Address - Phone:248-336-8900
Practice Address - Fax:248-336-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010099793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2138592OtherPK