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General NPI Number Information
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NPI Number | 1477990117
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Entity Type | Organization
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Legal Business Name | PARK SPECIALTY SERVICES LLC
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Dates
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Enumeration Date | 06/03/2013
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Last Update Date | 12/30/2013
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Provider Practice Location Address
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Address Line | 14726 CHAMPAIGN RD
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City | ALLEN PARK
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State | MI
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Zip | 48101-1617
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Country | US
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Telephone | 313-382-0000
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Fax | 313-382-0002
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Provider Business Mailing Address
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Address Line | 14726 CHAMPAIGN RD
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City | ALLEN PARK
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State | MI
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Zip | 48101-1617
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Country | US
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Telephone | 313-382-0000
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Fax | 313-382-0002
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Authorized Official
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Title or Position | OWNER
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Name | GHADA ABDALLAH
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Credential | RPH
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Telephone | 313-622-7465
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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 | 5315062632
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License Number State | MI
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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 | 5301010170
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License Number State | MI
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