Provider Demographics
NPI:1174907745
Name:PRIMEMART PHARMACY, LLC
Entity type:Organization
Organization Name:PRIMEMART PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENEESHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-961-4249
Mailing Address - Street 1:27177 LAHSER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-4714
Mailing Address - Country:US
Mailing Address - Phone:248-352-3400
Mailing Address - Fax:248-352-2995
Practice Address - Street 1:27177 LAHSER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-4714
Practice Address - Country:US
Practice Address - Phone:248-352-3400
Practice Address - Fax:248-352-2995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy