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General NPI Number Information
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NPI Number | 1346592920
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Entity Type | Organization
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Legal Business Name | AMIGO LLC
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 08/12/2021
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Provider Practice Location Address
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Address Line | 8656 WYOMING ST.
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City | DETROIT
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State | MI
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Zip | 48204-5216
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Country | US
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Telephone | 313-331-1200
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Fax | 313-331-1201
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Provider Business Mailing Address
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Address Line | 8656 WYOMING ST
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City | DETROIT
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State | MI
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Zip | 48204
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Country | US
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Telephone | 313-331-1200
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Fax | 313-331-1201
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE/PRESIDENT
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Name | AHMED SHARAF
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Credential | PHARM. D.
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Telephone | 313-331-1200
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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 | 5301009913
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License Number State | MI
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