Medsource Family Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301011057 Issued in MI

Legal business name

MEDSOURCE FAMILY PHARMACY LLC

Practice address

15300 W 9 Mile Rd Ste 2
Oak Park, MI 48237-5200

Phone

(248) 850-8594

Fax

(248) 629-9839

NPI assigned

Aug 26, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Hadi Dagher, RPH

Title

Owner, Pic, Ao

Phone

(313) 717-2900

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• MEDSOURCE PHARMACY Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484697600000",
    "number": "1174079560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15300 W 9 MILE RD STE 2",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "482375200",
            "telephone_number": "248-850-8594",
            "fax_number": "248-629-9839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15300 W 9 MILE RD STE 2",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "482375200",
            "telephone_number": "248-850-8594",
            "fax_number": "248-629-9839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDSOURCE FAMILY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-26",
        "last_updated": "2017-01-18",
        "status": "A",
        "authorized_official_last_name": "DAGHER",
        "authorized_official_first_name": "HADI",
        "authorized_official_title_or_position": "OWNER, PIC, AO",
        "authorized_official_telephone_number": "313-717-2900",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301011057",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2163895",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDSOURCE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Oak Park, MI
• Providers in Oak Park, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.