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General NPI Number Information
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NPI Number | 1750566451
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Entity Type | Organization
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Legal Business Name | PRO CARE PHARMACY LLC
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 01/02/2008
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Provider Practice Location Address
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Address Line | 6468 GREENFIELD RD
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City | DEARBORN
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State | MI
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Zip | 48126-2061
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Country | US
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Telephone | 313-582-0600
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Fax | 313-582-0606
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Provider Business Mailing Address
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Address Line | 6468 GREENFIELD RD
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City | DEARBORN
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State | MI
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Zip | 48126-2061
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOHAMED SOHOUBAH
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Credential |
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Telephone | 313-467-4164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 5310100867
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License Number State | MI
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