Healthcare Provider Details

I. General information

NPI: 1558488924
Provider Name (Legal Business Name): THE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1549 HOLMES RD
YPSILANTI MI
48198-4147
US

IV. Provider business mailing address

5204 JACKSON RD STE C
ANN ARBOR MI
48103-1866
US

V. Phone/Fax

Practice location:
  • Phone: 734-547-9100
  • Fax: 734-547-9144
Mailing address:
  • Phone: 734-821-8000
  • Fax: 734-821-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301008596
License Number StateMI

VIII. Authorized Official

Name: EIHAB SWIDAN
Title or Position: VP OPER
Credential:
Phone: 734-657-9769