Healthcare Provider Details

I. General information

NPI: 1184908345
Provider Name (Legal Business Name): MARY R KARADSHEH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50840 SHELBY RD
SHELBY TWP MI
48317-1252
US

IV. Provider business mailing address

2193 SCARBORO CT
SHELBY TWP MI
48316-1266
US

V. Phone/Fax

Practice location:
  • Phone: 586-731-6660
  • Fax:
Mailing address:
  • Phone: 586-871-4670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302034863
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number5302034863
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: