MEDICARE: YEREVAN PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5301001931	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083714687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YEREVAN PHARMACY INC

Provider Business Mailing Address
First Line	:	10507 W JEFFERSON AVE
Second Line	:
City	:	RIVER ROUGE
State	:	MI
Zip	:	48218-1306
Country	:	US
Telephone Number	:	313-842-2080
Fax Number	:	313-842-7901

Provider Business Practice Location Address
First Line	:	10507 W JEFFERSON AVE
Second Line	:
City	:	RIVER ROUGE
State	:	MI
Zip	:	48218-1306
Country	:	US
Telephone Number	:	313-842-2080
Fax Number	:	313-842-7901

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. YERVANT Y BEDIKIAN
Credential	:	RPH
Telephone Number	:	313-842-2080

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	06/23/2008

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