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General NPI Number Information
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NPI Number | 1831747096
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Entity Type | Organization
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Legal Business Name | MODERN HEALTH PHARMACY OF BIRMINGHAM
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Dates
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Enumeration Date | 08/30/2019
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Last Update Date | 08/30/2019
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Provider Practice Location Address
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Address Line | 33722 WOODWARD AVE STE B
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City | BIRMINGHAM
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State | MI
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Zip | 48009-0912
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Country | US
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Telephone | 313-333-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 33722 WOODWARD AVE STE B
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City | BIRMINGHAM
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State | MI
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Zip | 48009-0912
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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 | OWNER
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Name | MOHAMMED FAWAZ
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Credential | PHARM D
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Telephone | 313-333-3333
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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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