Provider Demographics
NPI:1386713840
Name:ASA RX
Entity type:Organization
Organization Name:ASA RX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALIDAH
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHOO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:734-451-5009
Mailing Address - Street 1:1102 ANN ARBOR RD W
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2131
Mailing Address - Country:US
Mailing Address - Phone:734-451-5009
Mailing Address - Fax:734-451-2413
Practice Address - Street 1:1102 ANN ARBOR RD W
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2131
Practice Address - Country:US
Practice Address - Phone:734-451-5009
Practice Address - Fax:734-451-2413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4810241Medicaid
MI5574620001Medicare NSC