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NPI Code Detail

MEDICARE: DOLA BYE PHARMD

MEDICARE: DOLA BYE PHARMD
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
1183500000XPharmacist5302038807MI

General Provider Information

NPI Number : 1164859534
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOLA BYE PHARMD
Provider Business Mailing Address
First Line : 745 ADAMS ST
Second Line :
City : PLYMOUTH
State : MI
Zip : 48170-1257
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7380 ORCHARD LAKE RD
Second Line :
City : WEST BLOOMFIELD
State : MI
Zip : 48322-3621
Country : US
Telephone Number : 248-538-8373
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2013
Last Update Date : 10/01/2013

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