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General NPI Number Information
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NPI Number | 1619058948
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL APOTHECARY,INC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 241 INKSTER RD
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City | GARDEN CITY
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State | MI
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Zip | 48135-4116
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Country | US
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Telephone | 734-266-7878
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Fax |
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Provider Business Mailing Address
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Address Line | 241 INKSTER RD
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City | GARDEN CITY
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State | MI
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Zip | 48135-4116
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Country | US
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Telephone | 734-266-7878
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMI A ABOUALAIWI
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Credential | RPH
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Telephone | 734-266-7878
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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 | 5301006251
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License Number State | MI
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