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General NPI Number Information
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NPI Number | 1154584779
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Entity Type | Organization
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Legal Business Name | TROY MB PHARMACY INC
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 35200 DEQUINDRE RD STE 200
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310-4837
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Country | US
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Telephone | 586-978-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 35200 DEQUINDRE RD STE 200
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310-4837
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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 | OWNER
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Name | ADEL MAKKI
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Credential | PHARM D
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Telephone | 313-598-3833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336M0003X
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Taxonomy Name | Managed Care Organization Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301008835
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License Number State | MI
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