MEDICARE: PROFESSIONAL APOTHECARY,INC

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	333600000X	Pharmacy	5301006251	MI

General Provider Information

NPI Number	:	1619058948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL APOTHECARY,INC

Provider Business Mailing Address
First Line	:	241 INKSTER RD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-4116
Country	:	US
Telephone Number	:	734-266-7878
Fax Number	:

Provider Business Practice Location Address
First Line	:	241 INKSTER RD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-4116
Country	:	US
Telephone Number	:	734-266-7878
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SAMI A ABOUALAIWI
Credential	:	RPH
Telephone Number	:	734-266-7878

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	08/22/2020

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