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General NPI Number Information
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NPI Number | 1457893125
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Entity Type | Organization
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Legal Business Name | HARPER WOODS MEDICAL PHARMACY LLC
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Dates
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Enumeration Date | 11/13/2016
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Last Update Date | 03/14/2017
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Provider Practice Location Address
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Address Line | 19959 VERNIER RD STE 100
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City | HARPER WOODS
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State | MI
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Zip | 48225-1471
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Country | US
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Telephone | 313-521-7000
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Fax | 313-521-7011
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Provider Business Mailing Address
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Address Line | 19959 VERNIER RD STE 100
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City | HARPER WOODS
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State | MI
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Zip | 48225-1471
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Country | US
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Telephone | 313-521-7000
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Fax | 313-521-7011
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | AMAL M SHUAYTO
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Credential | PHARMACIST
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Telephone | 313-521-7000
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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 | 5301011052
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License Number State | MI
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