Provider Demographics
NPI:1801022702
Name:MICHIGAN SPECIALTY PHARMACY LLC
Entity Type:Organization
Organization Name:MICHIGAN SPECIALTY PHARMACY LLC
Other - Org Name:FRJ FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-888-9921
Mailing Address - Street 1:9801 CONANT ST STE A
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3308
Mailing Address - Country:US
Mailing Address - Phone:313-888-9921
Mailing Address - Fax:313-262-6125
Practice Address - Street 1:9801 CONANT ST STE A
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3308
Practice Address - Country:US
Practice Address - Phone:313-467-2130
Practice Address - Fax:989-755-7993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010091303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2120572OtherPK