Provider Demographics
NPI:1215488689
Name:CITIZENS PHARMACY INC
Entity type:Organization
Organization Name:CITIZENS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:NADA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOUDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-855-6500
Mailing Address - Street 1:15537 SCHOOLCRAFT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1755
Mailing Address - Country:US
Mailing Address - Phone:313-770-7771
Mailing Address - Fax:
Practice Address - Street 1:15537 SCHOOLCRAFT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-1755
Practice Address - Country:US
Practice Address - Phone:313-770-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301011028302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization