Provider Demographics
NPI:1851847776
Name:MEDICAL SYNC PHARMACY LLC
Entity Type:Organization
Organization Name:MEDICAL SYNC PHARMACY LLC
Other - Org Name:MED SYNC PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSAIDI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:313-333-0165
Mailing Address - Street 1:2325 S VENOY RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-4662
Mailing Address - Country:US
Mailing Address - Phone:734-329-2454
Mailing Address - Fax:734-329-2455
Practice Address - Street 1:2325 S VENOY RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-4662
Practice Address - Country:US
Practice Address - Phone:734-329-2454
Practice Address - Fax:734-329-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010109903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1851847776Medicaid
2163867OtherPK