Healthcare Provider Details

I. General information

NPI: 1124397138
Provider Name (Legal Business Name): SAMEER M JARIWALA PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9950 WAYNE RD STE 200
ROMULUS MI
48174-3429
US

IV. Provider business mailing address

9950 WAYNE RD STE 200
ROMULUS MI
48174-3429
US

V. Phone/Fax

Practice location:
  • Phone: 734-857-7400
  • Fax:
Mailing address:
  • Phone: 734-895-3905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302034522
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: