Healthcare Provider Details

I. General information

NPI: 1346164530
Provider Name (Legal Business Name): WATTLES RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 E WATTLES RD
TROY MI
48085-5083
US

IV. Provider business mailing address

1903 E WATTLES RD
TROY MI
48085-5083
US

V. Phone/Fax

Practice location:
  • Phone: 248-613-3237
  • Fax:
Mailing address:
  • Phone: 248-613-3237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOANNE SHAMOUN
Title or Position: OWNER/PIC
Credential: RPH
Phone: 248-613-3237