Provider Demographics
NPI:1447677257
Name:SHOPPERS PHARMACY LLC
Entity type:Organization
Organization Name:SHOPPERS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARB
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:248-207-3116
Mailing Address - Street 1:46670 W PONTIAC TRL STE 3
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-4040
Mailing Address - Country:US
Mailing Address - Phone:248-956-7999
Mailing Address - Fax:248-956-7998
Practice Address - Street 1:46670 W PONTIAC TRL STE 3
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48390-4040
Practice Address - Country:US
Practice Address - Phone:248-956-7999
Practice Address - Fax:248-956-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010103833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142785OtherPK