MEDICARE: CARE PLUS PHARMACY LLC

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	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	5301009461	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2374798	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1144524653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE PLUS PHARMACY LLC

Provider Business Mailing Address
First Line	:	14847 GRATIOT AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48205-1942
Country	:	US
Telephone Number	:	313-332-0575
Fax Number	:	313-469-0212

Provider Business Practice Location Address
First Line	:	14847 GRATIOT AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48205-1942
Country	:	US
Telephone Number	:	313-332-0575
Fax Number	:	313-469-0212

Authorized Official
Title or Position	:	OWNER
Name	:	MOHAMAD HAMADE
Credential	:	RPH
Telephone Number	:	313-258-1102

Provider Enumeration Date	:	12/28/2010
Last Update Date	:	03/03/2011

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Directions to “CARE PLUS PHARMACY LLC ” Practice Location

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