MEDICARE: GARDEN CITY DISCOUNT 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	5301008789	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2370776	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1174701171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDEN CITY DISCOUNT PHARMACY LLC

Provider Business Mailing Address
First Line	:	6204 MIDDLEBELT RD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-2409
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6204 MIDDLEBELT RD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-2409
Country	:	US
Telephone Number	:	734-525-3727
Fax Number	:	734-525-3743

Authorized Official
Title or Position	:	PRESIDENT-PHARMACIST
Name	:	NABIL MOUSSA
Credential	:	PHARMD
Telephone Number	:	734-525-3727

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	03/27/2009

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