Provider Demographics
NPI:1043602485
Name:SOUTHWEST FAMILY PHARMACY
Entity type:Organization
Organization Name:SOUTHWEST FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSUBARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-949-8426
Mailing Address - Street 1:5700 W VERNOR HWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-2158
Mailing Address - Country:US
Mailing Address - Phone:313-949-8426
Mailing Address - Fax:
Practice Address - Street 1:5700 W VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-2158
Practice Address - Country:US
Practice Address - Phone:313-949-8426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherPHARMACY