Healthcare Provider Details

I. General information

NPI: 1093044877
Provider Name (Legal Business Name): PATIENT CARE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15301 TIREMAN AVE
DEARBORN MI
48126-1045
US

IV. Provider business mailing address

15301 TIREMAN AVE
DEARBORN MI
48126-1045
US

V. Phone/Fax

Practice location:
  • Phone: 313-584-2400
  • Fax: 313-584-2404
Mailing address:
  • Phone: 313-584-2400
  • Fax: 313-584-2404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301009285
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AHMAD ABBAS
Title or Position: OWNER / PIC
Credential: PHARMD
Phone: 313-680-2452