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1790295954 NPI number — CLINIC RX 6 LLC

NPI Number: 1790295954
Health Care Provider/Practitioner: CLINIC RX 6 LLC

Information about “1790295954” NPI (CLINIC RX 6 LLC) exists in 1790295954 in HTML format HTML  |  1790295954 in plain Text format TXT  |  1790295954 in PDF (Portable Document Format) PDF  |  1790295954 in an XML format XML  formats.

NPI Number : 1790295954 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790295954",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CLINIC RX 6 LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7651 SCHAEFER RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DEARBORN",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48126-1143",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "586-480-2022",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "19011 E 10 MILE RD STE B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROSEVILLE",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48066-3901",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "586-480-2022",
    "PracticeLocationAddressFaxNumber": "586-842-3666",
    "EnumerationDate": "10/02/2017",
    "LastUpdateDate": "09/19/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KHASHAB",
    "AuthorizedOfficialFirstName": "ALI",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "313-213-4993",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "333600000X",
          "TaxonomyName": "Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "5301011257",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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