Provider Demographics
NPI:1255435210
Name:MED-CARE PHARMACY INC
Entity type:Organization
Organization Name:MED-CARE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, RPH
Authorized Official - Prefix:
Authorized Official - First Name:AYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-559-9901
Mailing Address - Street 1:7404 SILVER LEAF LN
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3350
Mailing Address - Country:US
Mailing Address - Phone:248-788-4309
Mailing Address - Fax:
Practice Address - Street 1:28500 SOUTHFIELD RD
Practice Address - Street 2:STE 300
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2722
Practice Address - Country:US
Practice Address - Phone:248-559-9901
Practice Address - Fax:248-559-9904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 332B00000X
MI53010080493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2046952OtherPK
MI2366614Medicaid
2046952OtherPK