Provider Demographics
NPI:1174666234
Name:HAMTRAMCK DRUGS INC
Entity type:Organization
Organization Name:HAMTRAMCK DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:KASPRZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-873-2366
Mailing Address - Street 1:10300 JOSEPH CAMPAU ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3260
Mailing Address - Country:US
Mailing Address - Phone:313-873-2366
Mailing Address - Fax:313-873-2368
Practice Address - Street 1:10300 JOSEPH CAMPAU ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3260
Practice Address - Country:US
Practice Address - Phone:313-873-2366
Practice Address - Fax:313-873-2368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010072203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2044776OtherPK
MI2361753Medicaid