Provider Demographics
NPI:1700979655
Name:THE PHARMACY SHOP
Entity Type:Organization
Organization Name:THE PHARMACY SHOP
Other - Org Name:THE PHARMACY SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHEHAB
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:248-591-5555
Mailing Address - Street 1:28411 DEQUINDRE
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071
Mailing Address - Country:US
Mailing Address - Phone:248-591-5555
Mailing Address - Fax:248-591-7136
Practice Address - Street 1:28411 DEQUINDRE
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071
Practice Address - Country:US
Practice Address - Phone:248-591-5555
Practice Address - Fax:248-591-7136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027828183500000X
MI53010076003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty