Provider Demographics
NPI:1992235535
Name:GMC PHARMACY LLC
Entity type:Organization
Organization Name:GMC PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAISARI
Authorized Official - Suffix:
Authorized Official - Credentials:LLC
Authorized Official - Phone:586-213-5659
Mailing Address - Street 1:43614 GARFIELD RD STE B
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1120
Mailing Address - Country:US
Mailing Address - Phone:586-213-5659
Mailing Address - Fax:
Practice Address - Street 1:43614 GARFIELD RD STE B
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1120
Practice Address - Country:US
Practice Address - Phone:586-213-5659
Practice Address - Fax:586-213-5695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010111733336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy