Healthcare Provider Details

I. General information

NPI: 1790150266
Provider Name (Legal Business Name): ZMC PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 S MAIN ST FL1
ROYAL OAK MI
48067-3274
US

IV. Provider business mailing address

1041 S MAIN ST FL1
ROYAL OAK MI
48067-3274
US

V. Phone/Fax

Practice location:
  • Phone: 248-280-6401
  • Fax: 248-280-6411
Mailing address:
  • Phone: 248-280-6401
  • Fax: 248-280-6411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number5301008889
License Number StateMI

VIII. Authorized Official

Name: DR. JALAL ZAWAIDEH
Title or Position: PRINCIPAL
Credential: PHARMD
Phone: 248-280-6409