Healthcare Provider Details

I. General information

NPI: 1720190721
Provider Name (Legal Business Name): NORMA ABDALLAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22341 W 8 MILE RD
DETROIT MI
48219-1217
US

IV. Provider business mailing address

22341 W 8 MILE RD
DETROIT MI
48219-1217
US

V. Phone/Fax

Practice location:
  • Phone: 313-533-1422
  • Fax: 313-533-1488
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301007973
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NORMA ABDALLAH
Title or Position: PRESIDENT
Credential:
Phone: 313-533-1422