Healthcare Provider Details

I. General information

NPI: 1982344388
Provider Name (Legal Business Name): PNG RX CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 LAKE WIND DR
WEST BLOOMFIELD MI
48324-1823
US

IV. Provider business mailing address

2034 LAKE WIND DR
WEST BLOOMFIELD MI
48324-1823
US

V. Phone/Fax

Practice location:
  • Phone: 248-565-7113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number
License Number State

VIII. Authorized Official

Name: ROUA DABAL
Title or Position: OWNER/FOUNDER/CEO
Credential: PHARMD
Phone: 248-565-7113