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General NPI Number Information
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NPI Number | 1154567238
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Entity Type | Organization
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Legal Business Name | DABAJA PHARMACY LLC
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Dates
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Enumeration Date | 12/19/2008
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Last Update Date | 01/06/2009
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Provider Practice Location Address
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Address Line | 2610 WASHTENAW RD
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City | YPSILANTI
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State | MI
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Zip | 48197-1505
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Country | US
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Telephone | 734-528-9400
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Fax | 734-528-9406
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Provider Business Mailing Address
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Address Line | 2610 WASHTENAW RD
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City | YPSILANTI
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State | MI
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Zip | 48197-1505
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MOE DAJABA
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Credential |
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Telephone | 313-212-8165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301009017
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License Number State | MI
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