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General NPI Number Information
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NPI Number | 1568094332
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Entity Type | Organization
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Legal Business Name | BERKLEY MEDICAL CENTER PHARMACY LLC
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 1695 W 12 MILE RD # 210
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City | BERKLEY
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State | MI
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Zip | 48072-2182
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Country | US
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Telephone | 248-262-7679
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Fax |
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Provider Business Mailing Address
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Address Line | 27207 LAHSER RD STE 102
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City | SOUTHFIELD
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State | MI
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Zip | 48034-8470
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Country | US
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Telephone | 248-262-7679
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Fax | 248-262-7973
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Authorized Official
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Title or Position | OWNER
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Name | DR. HADY BEYDOUN
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Credential | PHARMD
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Telephone | 313-844-7447
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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 |
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License Number State |
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