MEDICARE: ROSA PARK MEDICAL PHARMACY LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	5301008435	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2042324	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164437992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSA PARK MEDICAL PHARMACY LLC

Provider Business Mailing Address
First Line	:	8665 ROSA PARKS BOULAVARD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48206
Country	:	US
Telephone Number	:	313-361-8800
Fax Number	:	313-361-8875

Provider Business Practice Location Address
First Line	:	8665 ROSA PARKS BOULAVARD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48206
Country	:	US
Telephone Number	:	313-361-8800
Fax Number	:	313-361-8875

Authorized Official
Title or Position	:	PHARMACIST
Name	:	AHMED SAID
Credential	:	PHARMD
Telephone Number	:	313-377-8876

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	04/19/2018

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