Provider Demographics
NPI:1053721464
Name:BRITAM PHARMACY LLC
Entity type:Organization
Organization Name:BRITAM PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KINGSLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JADEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-862-8888
Mailing Address - Street 1:10832 PURITAN ST
Mailing Address - Street 2:STE #2
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-1025
Mailing Address - Country:US
Mailing Address - Phone:313-862-8888
Mailing Address - Fax:313-862-8889
Practice Address - Street 1:10832 PURITAN ST STE 2
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-1025
Practice Address - Country:US
Practice Address - Phone:313-862-8888
Practice Address - Fax:313-862-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010104293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145582OtherPK