=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508655077
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHIFA PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2025
-----------------------------------------------------
Last Update Date | 05/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13530 MICHIGAN AVE STE 180
-----------------------------------------------------
City | DEARBORN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48126-3555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-444-3944
-----------------------------------------------------
Fax | 313-444-3945
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13530 MICHIGAN AVE STE 180
-----------------------------------------------------
City | DEARBORN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48126-3555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-444-3944
-----------------------------------------------------
Fax | 313-444-3945
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE
-----------------------------------------------------
Name | ADHEM MAWARI
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 313-899-0763
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------