Healthcare Provider Details

I. General information

NPI: 1962801373
Provider Name (Legal Business Name): APOLLO MEDICAL PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20250 WEST 7 MILE ROAD
DETROIT MI
48219
US

IV. Provider business mailing address

20250 W 7 MILE RD
DETROIT MI
48219-3469
US

V. Phone/Fax

Practice location:
  • Phone: 313-535-9755
  • Fax:
Mailing address:
  • Phone: 313-535-9755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number5315049752
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. OMAR ABAZEED
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 313-535-9755