Provider Demographics
NPI:1255087615
Name:PROSPECT PHARMACY LLC
Entity type:Organization
Organization Name:PROSPECT PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ARAFAT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-258-7688
Mailing Address - Street 1:3702 OAKWOOD BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:MELVINDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48122-1502
Mailing Address - Country:US
Mailing Address - Phone:313-258-7688
Mailing Address - Fax:
Practice Address - Street 1:3702 OAKWOOD BLVD STE 2
Practice Address - Street 2:
Practice Address - City:MELVINDALE
Practice Address - State:MI
Practice Address - Zip Code:48122-1502
Practice Address - Country:US
Practice Address - Phone:313-258-7688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy