Healthcare Provider Details

I. General information

NPI: 1144042839
Provider Name (Legal Business Name): PRIME ONE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5728 SCHAEFER RD STE 102
DEARBORN MI
48126-2287
US

IV. Provider business mailing address

5728 SCHAEFER RD STE 102
DEARBORN MI
48126-2287
US

V. Phone/Fax

Practice location:
  • Phone: 313-687-1937
  • Fax: 313-584-2254
Mailing address:
  • Phone: 313-687-1937
  • Fax: 313-584-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: FATIMAH FARHAT
Title or Position: PIC
Credential:
Phone: 313-687-1937