Healthcare Provider Details

I. General information

NPI: 1578989489
Provider Name (Legal Business Name): DALCOMA SPECIALTY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2014
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43337 SCHOENHERR RD
STERLING HEIGHTS MI
48313-1959
US

IV. Provider business mailing address

43337 SCHOENHERR RD
STERLING HEIGHTS MI
48313-1959
US

V. Phone/Fax

Practice location:
  • Phone: 586-697-3877
  • Fax: 586-697-3878
Mailing address:
  • Phone: 586-697-3877
  • Fax: 586-697-3878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301010422
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HIMAL SHAH
Title or Position: OWNER
Credential:
Phone: 248-566-0116