Provider Demographics
NPI:1912538828
Name:PASHA ENTERPRISE LLC
Entity Type:Organization
Organization Name:PASHA ENTERPRISE LLC
Other - Org Name:TRICARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TANVEER
Authorized Official - Middle Name:
Authorized Official - Last Name:PASHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-840-6084
Mailing Address - Street 1:43184 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1709
Mailing Address - Country:US
Mailing Address - Phone:760-840-6084
Mailing Address - Fax:
Practice Address - Street 1:43184 DEQUINDRE RD STE 209
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1709
Practice Address - Country:US
Practice Address - Phone:734-502-4293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy