Provider Demographics
NPI:1700086733
Name:THE RELIANCE GROUP
Entity Type:Organization
Organization Name:THE RELIANCE GROUP
Other - Org Name:RELIANCE PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:MISS
Authorized Official - First Name:REEM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-398-7796
Mailing Address - Street 1:4902 DEWITT RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2451
Mailing Address - Country:US
Mailing Address - Phone:734-398-7796
Mailing Address - Fax:734-398-7795
Practice Address - Street 1:4902 DEWITT RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2451
Practice Address - Country:US
Practice Address - Phone:734-398-7796
Practice Address - Fax:734-398-7795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010086603336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1700086733Medicaid
MI6209400001Medicare NSC