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General NPI Number Information
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NPI Number | 1871839944
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Entity Type | Organization
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Legal Business Name | OBAMA PHARMACY LLC
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Dates
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Enumeration Date | 12/18/2012
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 18400 PLYMOUTH RD
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City | DETROIT
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State | MI
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Zip | 48228-1126
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Country | US
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Telephone | 313-837-2000
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Fax | 313-837-2003
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Provider Business Mailing Address
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Address Line | 18400 PLYMOUTH RD
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City | DETROIT
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State | MI
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Zip | 48228-1126
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Country | US
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Telephone | 734-250-0562
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. GARRY NG
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Credential | RPH
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Telephone | 313-837-2000
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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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