Provider Demographics
NPI:1962946186
Name:WRIGLEYS PHARMACY LLC
Entity type:Organization
Organization Name:WRIGLEYS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER, TECH, AO
Authorized Official - Prefix:
Authorized Official - First Name:NEBILL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-867-5000
Mailing Address - Street 1:PO BOX 1243
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48121-1243
Mailing Address - Country:US
Mailing Address - Phone:313-867-5000
Mailing Address - Fax:313-867-5001
Practice Address - Street 1:14100 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-2936
Practice Address - Country:US
Practice Address - Phone:313-867-5000
Practice Address - Fax:313-867-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010110733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166645OtherPK