Provider Demographics
NPI:1790832848
Name:COMPREHENSIVE PHARMACY SOLUTIONS, PLLC
Entity type:Organization
Organization Name:COMPREHENSIVE PHARMACY SOLUTIONS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:FARDOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-525-0011
Mailing Address - Street 1:8024 N MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8024 N MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1808
Practice Address - Country:US
Practice Address - Phone:734-525-0011
Practice Address - Fax:734-525-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010085613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2369305OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MI2369305Medicaid