MEDICARE: DR. ROUA RIYAD DABAL PHARMD

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	5302041512	MI

General Provider Information

NPI Number	:	1407305089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROUA RIYAD DABAL PHARMD

Provider Business Mailing Address
First Line	:	2034 LAKE WIND DR
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48324-1823
Country	:	US
Telephone Number	:	248-565-7113
Fax Number	:

Provider Business Practice Location Address
First Line	:	3669 W MAPLE RD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-3376
Country	:	US
Telephone Number	:	248-647-4900
Fax Number	:

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

Provider Enumeration Date	:	09/24/2016
Last Update Date	:	09/24/2016

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