Provider Demographics
NPI:1922451806
Name:SALUD PHARMACY LLC
Entity Type:Organization
Organization Name:SALUD PHARMACY LLC
Other - Org Name:FARMACITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NASSEEM
Authorized Official - Middle Name:M
Authorized Official - Last Name:SALEH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:313-789-8934
Mailing Address - Street 1:3456 W VERNOR HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48216-1551
Mailing Address - Country:US
Mailing Address - Phone:313-789-8934
Mailing Address - Fax:313-908-1069
Practice Address - Street 1:3456 W VERNOR HWY
Practice Address - Street 2:SUITE B
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48216-1551
Practice Address - Country:US
Practice Address - Phone:313-789-8934
Practice Address - Fax:313-908-1069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-15
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
MI53010110183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162196OtherPK
MI1922451806Medicaid