Provider Demographics
NPI:1902196033
Name:MARKET PHARMACY LLC
Entity Type:Organization
Organization Name:MARKET PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TARICK
Authorized Official - Middle Name:N
Authorized Official - Last Name:IQAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-931-1319
Mailing Address - Street 1:12715 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1530
Mailing Address - Country:US
Mailing Address - Phone:248-931-1319
Mailing Address - Fax:
Practice Address - Street 1:12715 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1530
Practice Address - Country:US
Practice Address - Phone:248-931-1319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy