Healthcare Provider Details

I. General information

NPI: 1881857639
Provider Name (Legal Business Name): SOBH RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12701 TELEGRAPH RD STE 101A
TAYLOR MI
48180-6847
US

IV. Provider business mailing address

6767 WHITEFIELD ST
DEARBORN HEIGHTS MI
48127-4711
US

V. Phone/Fax

Practice location:
  • Phone: 734-225-8010
  • Fax: 734-225-8011
Mailing address:
  • Phone: 313-622-0432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301008973
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MOHAMAD SOBH
Title or Position: PIC/OFFICER
Credential:
Phone: 313-622-0432