MEDICARE: DEARBORN FAMILY 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

General Provider Information

NPI Number	:	1912270489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEARBORN FAMILY PHARMACY

Provider Business Mailing Address
First Line	:	17000 EXECUTIVE PLAZA DR
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-2610
Country	:	US
Telephone Number	:	313-523-5334
Fax Number	:	313-441-3700

Provider Business Practice Location Address
First Line	:	17000 EXECUTIVE PLAZA DR
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-2610
Country	:	US
Telephone Number	:	313-523-5334
Fax Number	:	313-441-3700

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	MR. AIMAN ABUEIDA
Credential	:
Telephone Number	:	313-523-5334

Provider Enumeration Date	:	02/14/2012
Last Update Date	:	10/03/2012

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