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General NPI Number Information
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NPI Number | 1558700138
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Entity Type | Organization
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Legal Business Name | SAM'S PHARMACY PLLC
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Dates
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Enumeration Date | 06/18/2013
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Last Update Date | 09/14/2024
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Provider Practice Location Address
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Address Line | 14533 LIVERNOIS AVENUE
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City | DETROIT
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State | MI
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Zip | 48238-2010
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Country | US
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Telephone | 313-340-7777
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Fax | 313-340-4449
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Provider Business Mailing Address
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Address Line | 14533 LIVERNOIS AVENUE
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City | DETROIT
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State | MI
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Zip | 48238-2010
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Country | US
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Telephone | 313-340-7777
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Fax | 313-340-4449
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Authorized Official
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Title or Position | PIC AND OWNER
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Name | BASSAM HARATI
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Credential |
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Telephone | 313-340-7777
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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 | 5301010118
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License Number State | MI
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