Provider Demographics
NPI:1821530999
Name:MARSHALL FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:MARSHALL FAMILY PHARMACY LLC
Other - Org Name:MARSHALL FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BILAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAABAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-789-5509
Mailing Address - Street 1:25022 W WARREN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2145
Mailing Address - Country:US
Mailing Address - Phone:313-789-5509
Mailing Address - Fax:313-789-5676
Practice Address - Street 1:25022 W WARREN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2145
Practice Address - Country:US
Practice Address - Phone:313-789-5576
Practice Address - Fax:313-789-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010110293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166142OtherPK