Provider Demographics
NPI:1841576071
Name:QUICKMED PHARMACY
Entity Type:Organization
Organization Name:QUICKMED PHARMACY
Other - Org Name:QUICKMED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIF
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMADE-MOUBARAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-289-5414
Mailing Address - Street 1:235 INKSTER RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-4116
Mailing Address - Country:US
Mailing Address - Phone:734-525-7335
Mailing Address - Fax:
Practice Address - Street 1:235 INKSTER RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-4116
Practice Address - Country:US
Practice Address - Phone:734-525-7335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010096803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2376007OtherNCPDP PROVIDER IDENTIFICATION NUMBER