Provider Demographics
NPI:1821049891
Name:PHARMAP LLC
Entity Type:Organization
Organization Name:PHARMAP LLC
Other - Org Name:TOP SERVICE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-348-1570
Mailing Address - Street 1:15600 W 10 MILE RD
Mailing Address - Street 2:UNIT 1B
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2147
Mailing Address - Country:US
Mailing Address - Phone:248-569-7578
Mailing Address - Fax:248-569-7868
Practice Address - Street 1:15600 W 10 MILE RD
Practice Address - Street 2:UNIT 1B
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2147
Practice Address - Country:US
Practice Address - Phone:248-569-7578
Practice Address - Fax:248-569-7868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010083853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2042305OtherPK
MI2368327Medicaid
5704940001Medicare NSC