Healthcare Provider Details

I. General information

NPI: 1306751276
Provider Name (Legal Business Name): JOHN SHABA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4909 FLOWER HILL DR
TROY MI
48098-6622
US

IV. Provider business mailing address

4909 FLOWER HILL DR
TROY MI
48098-6622
US

V. Phone/Fax

Practice location:
  • Phone: 248-933-8386
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5351018478
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: