Provider Demographics
NPI:1487755096
Name:GHAMAR INC
Entity type:Organization
Organization Name:GHAMAR INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GHASSAN
Authorized Official - Middle Name:I
Authorized Official - Last Name:YAZBECK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-871-3285
Mailing Address - Street 1:2676 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-1237
Mailing Address - Country:US
Mailing Address - Phone:313-871-3285
Mailing Address - Fax:313-871-0788
Practice Address - Street 1:2676 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-1237
Practice Address - Country:US
Practice Address - Phone:313-871-3285
Practice Address - Fax:313-871-0788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010049553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2344151Medicare UPIN
MI4703860001Medicare NSC