Provider Demographics
NPI:1982718656
Name:BROTHERHOOD INC
Entity Type:Organization
Organization Name:BROTHERHOOD INC
Other - Org Name:JOY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:AYMAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:734-266-9018
Mailing Address - Street 1:27543 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2253
Mailing Address - Country:US
Mailing Address - Phone:734-266-9018
Mailing Address - Fax:734-266-9020
Practice Address - Street 1:27543 WARREN RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2253
Practice Address - Country:US
Practice Address - Phone:734-266-9018
Practice Address - Fax:734-266-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010078023336C0003X, 333600000X
MI5302029511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2365597OtherNCPDP
MI540H222460OtherBCBSM DME
MI874622493Medicaid
MI2365597OtherNCPDP
MI2365597OtherNCPDP