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General NPI Number Information
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NPI Number | 1376846980
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Entity Type | Organization
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Legal Business Name | SAV-MART PHARMACY-GRATIOT LLC
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Dates
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Enumeration Date | 12/21/2010
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Last Update Date | 08/16/2013
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Provider Practice Location Address
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Address Line | 7011 GRATIOT AVE
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City | DETROIT
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State | MI
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Zip | 48207-1973
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Country | US
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Telephone | 313-923-0007
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Fax | 313-923-0098
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Provider Business Mailing Address
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Address Line | 23815 NORTHWESTERN HWY SUITE 200
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City | SOUTHFIELD
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State | MI
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Zip | 48075-7738
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Country | US
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Telephone | 248-663-3380
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Fax | 248-223-1061
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Authorized Official
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Title or Position | OWNER
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Name | ABDO SHOUBAH
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Credential |
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Telephone | 313-923-0007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301009409
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License Number State | MI
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