Provider Demographics
NPI:1841363975
Name:SALEM'S PHARMACY INC.
Entity type:Organization
Organization Name:SALEM'S PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RIEAD
Authorized Official - Middle Name:S
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:734-487-8500
Mailing Address - Street 1:313 ECORSE RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5733
Mailing Address - Country:US
Mailing Address - Phone:734-487-8500
Mailing Address - Fax:734-487-8502
Practice Address - Street 1:313 ECORSE RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5733
Practice Address - Country:US
Practice Address - Phone:734-487-8500
Practice Address - Fax:734-487-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010055393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2348212OtherNABP #
MI2348212OtherBCBS MICHIGAN
MI2348212Medicaid