Provider Demographics
NPI:1699068254
Name:ULTRACARE PHARMACY LLC
Entity type:Organization
Organization Name:ULTRACARE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TANVEER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-645-1088
Mailing Address - Street 1:3530 CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-5038
Mailing Address - Country:US
Mailing Address - Phone:313-645-1088
Mailing Address - Fax:313-368-9987
Practice Address - Street 1:3530 CARPENTER ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-2766
Practice Address - Country:US
Practice Address - Phone:313-645-1088
Practice Address - Fax:313-368-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010096663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy