Organization
FAIRLANE MEDICAL PHARMACY INC
Active
Other names
FAIRLANE MEDICAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMMED IBRAHIM RPH (MEMBER)
(313) 526-8000
Entity
Organization
Contact information
Practice address
6050 GREENFIELD RD, DEARBORN, MI 48126-6004
(313) 526-8000
(313) 526-8001
Mailing address
PO BOX 1147, DEARBORN, MI 48121-1147
(313) 526-8000
(313) 526-8001
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301009570
MI
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023309788
—
MI
01
—
2375447
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/28/2011
Last updated
06/22/2011
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us