MEDICARE: SAMUEL AYOUB

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	5302412060	MI

General Provider Information

NPI Number	:	1982221859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL AYOUB

Provider Business Mailing Address
First Line	:	1421 KIRKWAY RD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-1318
Country	:	US
Telephone Number	:	313-434-7882
Fax Number	:

Provider Business Practice Location Address
First Line	:	34300 WOODWARD AVE
Second Line	:
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-0919
Country	:	US
Telephone Number	:	248-593-8450
Fax Number	:

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

Provider Enumeration Date	:	06/26/2020
Last Update Date	:	06/26/2020

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