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General NPI Number Information
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NPI Number | 1891147617
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Entity Type | Organization
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Legal Business Name | MEDPRO PHARMACY LLC
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Dates
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Enumeration Date | 07/05/2016
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 15580 MIDDLEBELT RD
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City | LIVONIA
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State | MI
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Zip | 48154-3808
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Country | US
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Telephone | 734-855-4700
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Fax | 734-855-4701
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Provider Business Mailing Address
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Address Line | 15580 MIDDLEBELT RD
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City | LIVONIA
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State | MI
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Zip | 48154-3808
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Country | US
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Telephone | 734-855-4700
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Fax | 734-855-4701
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Authorized Official
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Title or Position | OWNER, PIC, AO
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Name | ZAMAN ALSHAFEY
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Credential | RPH
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Telephone | 734-855-4700
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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 | 5301011053
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License Number State | MI
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