Provider Demographics
NPI:1194725705
Name:GABECARE DIRECTRX INC
Entity type:Organization
Organization Name:GABECARE DIRECTRX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERISHAJ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:248-280-2270
Mailing Address - Street 1:830 KIRTS BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4897
Mailing Address - Country:US
Mailing Address - Phone:248-280-2270
Mailing Address - Fax:248-280-6405
Practice Address - Street 1:830 KIRTS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4897
Practice Address - Country:US
Practice Address - Phone:248-280-2270
Practice Address - Fax:248-280-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336M0002X, 3336S0011X
MI53010064113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3239850Medicaid
2044355OtherPK
MI1715051Medicaid
MI3239850Medicaid