Healthcare Provider Details

I. General information

NPI: 1356553200
Provider Name (Legal Business Name): PROCARE PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13111 WOODWARD AVE
HIGHLAND PARK MI
48203-3781
US

IV. Provider business mailing address

13111 WOODWARD AVE
HIGHLAND PARK MI
48203
US

V. Phone/Fax

Practice location:
  • Phone: 313-865-9900
  • Fax: 313-865-9910
Mailing address:
  • Phone: 313-865-9900
  • Fax: 313-865-9910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number5301008466
License Number StateMI

VIII. Authorized Official

Name: SAMMI OMAR
Title or Position: PRESIDENT
Credential: RPH
Phone: 313-330-2700