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General NPI Number Information
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NPI Number | 1669884524
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Entity Type | Organization
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Legal Business Name | PREMIUM PHARMACY LLC
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Dates
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Enumeration Date | 05/27/2014
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 3808 MONROE ST
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City | DEARBORN
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State | MI
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Zip | 48124-3620
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Country | US
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Telephone | 313-209-3339
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Fax | 313-586-9522
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Provider Business Mailing Address
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Address Line | 3808 MONROE ST
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City | DEARBORN
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State | MI
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Zip | 48124-3620
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Country | US
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Telephone | 313-768-8494
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Fax | 313-586-9522
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. WAFAA DAKHLALLAH HAKIM
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Credential | PHARM D
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Telephone | 313-209-3339
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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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