MEDICARE: HOLIDAY PHARMACY PLLC

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
2	3336C0003X	Community/Retail Pharmacy	5301003121	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2040962	OTHER	PK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952380065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLIDAY PHARMACY PLLC

Provider Business Mailing Address
First Line	:	6443 INKSTER RD
Second Line	:	STE 170F
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-1318
Country	:	US
Telephone Number	:	586-274-4332
Fax Number	:	586-274-4828

Provider Business Practice Location Address
First Line	:	37771 SCHOENHERR RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48312-2302
Country	:	US
Telephone Number	:	586-274-4332
Fax Number	:	586-274-4828

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	R MELODY SHANBAUM
Credential	:
Telephone Number	:	248-546-5500

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	03/12/2021

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Directions to “HOLIDAY PHARMACY PLLC ” Practice Location

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