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General NPI Number Information
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NPI Number | 1891661096
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Entity Type | Organization
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Legal Business Name | SAM'S PHARMACY PLLC LONG TERM CARE
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Dates
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Enumeration Date | 10/14/2025
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Last Update Date | 11/01/2025
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Provider Practice Location Address
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Address Line | 14533 LIVERNOIS AVE
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City | DETROIT
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State | MI
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Zip | 48238-2010
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Country | US
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Telephone | 313-525-0110
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Fax | 313-340-4449
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Provider Business Mailing Address
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Address Line | 14533 LIVERNOIS AVE
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City | DETROIT
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State | MI
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Zip | 48238-2010
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Country | US
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Telephone | 313-340-7777
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Fax | 313-340-4449
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Authorized Official
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Title or Position | PIC PHARMD
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Name | BASSAM HARATI
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Credential |
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Telephone | 313-340-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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