MEDICARE: RUSUL SOBY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302034651	MI

General Provider Information

NPI Number	:	1124772967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSUL SOBY

Provider Business Mailing Address
First Line	:	23291 BEECHCREST ST
Second Line	:
City	:	DEARBORN HTS
State	:	MI
Zip	:	48127-2305
Country	:	US
Telephone Number	:	313-729-6262
Fax Number	:

Provider Business Practice Location Address
First Line	:	23291 BEECHCREST ST
Second Line	:
City	:	DEARBORN HTS
State	:	MI
Zip	:	48127-2305
Country	:	US
Telephone Number	:	313-729-6262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2022
Last Update Date	:	04/10/2026

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Directions to “ RUSUL SOBY ” Practice Location

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