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General NPI Number Information
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NPI Number | 1790258069
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Entity Type | Organization
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Legal Business Name | MED-X PHARMACY PC
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Dates
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Enumeration Date | 01/09/2019
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Last Update Date | 08/17/2019
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Provider Practice Location Address
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Address Line | 14993 E 9 MILE RD
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City | EASTPOINTE
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State | MI
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Zip | 48021-2147
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Country | US
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Telephone | 586-859-5866
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Fax | 586-859-5867
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Provider Business Mailing Address
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Address Line | PO BOX 684
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City | DEARBORN
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State | MI
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Zip | 48121-0684
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Country | US
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Telephone | 586-859-5866
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Fax | 586-859-5867
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Authorized Official
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Title or Position | OWNER/PIC/AO
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Name | FARES A ALMUJAHID
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Credential |
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Telephone | 586-859-5866
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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 |
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License Number State |
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