Provider Demographics
NPI:1972611341
Name:JOY DEX PHARMACY
Entity Type:Organization
Organization Name:JOY DEX PHARMACY
Other - Org Name:JOY DEX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUNIR
Authorized Official - Middle Name:
Authorized Official - Last Name:AWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-894-2250
Mailing Address - Street 1:3418 JOY RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-1949
Mailing Address - Country:US
Mailing Address - Phone:313-894-2250
Mailing Address - Fax:313-894-2910
Practice Address - Street 1:3418 JOY RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1949
Practice Address - Country:US
Practice Address - Phone:313-894-2250
Practice Address - Fax:313-894-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315016501183500000X
MI53010078323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2365585OtherOTHER ID NUMBER
MI2365585Medicaid
5446740001Medicare NSC
2365585OtherOTHER ID NUMBER