Healthcare Provider Details

I. General information

NPI: 1629257936
Provider Name (Legal Business Name): OAKMAN PLUS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5237 OAKMAN BLVD
DEARBORN MI
48126-4045
US

IV. Provider business mailing address

22236 DOLPHIN CT
DEARBORN HEIGHTS MI
48127-2555
US

V. Phone/Fax

Practice location:
  • Phone: 313-582-9700
  • Fax: 313-852-9701
Mailing address:
  • Phone: 313-300-8082
  • Fax: 734-485-9300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301008725
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MOJEEB SHAHBAIN
Title or Position: PHCY MGR
Credential: RPH
Phone: 313-300-8082