Healthcare Provider Details

I. General information

NPI: 1700125523
Provider Name (Legal Business Name): JULIAS FAMILY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 PELHAM ST
DEARBORN HEIGHTS MI
48125-3118
US

IV. Provider business mailing address

3915 PELHAM ST
DEARBORN HEIGHTS MI
48125-3118
US

V. Phone/Fax

Practice location:
  • Phone: 313-551-3547
  • Fax: 313-551-3758
Mailing address:
  • Phone: 313-551-3547
  • Fax: 313-551-3758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5315073618
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHARIFE BAZZI
Title or Position: MR.
Credential:
Phone: 866-844-4142