Provider Demographics
NPI:1013140573
Name:JAY AMBEY LLC
Entity Type:Organization
Organization Name:JAY AMBEY LLC
Other - Org Name:BARRON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ATULKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GANDHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-219-5071
Mailing Address - Street 1:4870 W CLARK RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1104
Mailing Address - Country:US
Mailing Address - Phone:734-528-9144
Mailing Address - Fax:
Practice Address - Street 1:4870 W CLARK RD
Practice Address - Street 2:SUITE#108
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1104
Practice Address - Country:US
Practice Address - Phone:734-528-9144
Practice Address - Fax:734-528-9146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010091903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy