Provider Demographics
NPI:1396146577
Name:CAREWARD RX PHARMACY LLC
Entity type:Organization
Organization Name:CAREWARD RX PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-250-8600
Mailing Address - Street 1:18706 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2926
Mailing Address - Country:US
Mailing Address - Phone:734-250-8600
Mailing Address - Fax:734-250-7833
Practice Address - Street 1:18706 EUREKA RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2926
Practice Address - Country:US
Practice Address - Phone:734-250-8600
Practice Address - Fax:734-250-7833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
MI53010106003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148572OtherPK
MI1396146577Medicaid