MEDICARE: QUICKMED PHARMACY

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	3336C0003X	Community/Retail Pharmacy	5301009680	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2376007	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1841576071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUICKMED PHARMACY

Provider Business Mailing Address
First Line	:	235 INKSTER RD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-4116
Country	:	US
Telephone Number	:	734-525-7335
Fax Number	:

Provider Business Practice Location Address
First Line	:	235 INKSTER RD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-4116
Country	:	US
Telephone Number	:	734-525-7335
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST/OWNER
Name	:	RIF HAMADE-MOUBARAK
Credential	:
Telephone Number	:	313-289-5414

Provider Enumeration Date	:	11/02/2011
Last Update Date	:	11/02/2011

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Directions to “QUICKMED PHARMACY ” Practice Location

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