MEDICARE: ROUA DAHER PHARMACIST

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	5302415084	MI

General Provider Information

NPI Number	:	1215625140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROUA DAHER PHARMACIST

Provider Business Mailing Address
First Line	:	315 SADDLEBACK DR NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-3493
Country	:	US
Telephone Number	:	616-591-4822
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 SADDLEBACK DR NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-3493
Country	:	US
Telephone Number	:	616-591-4822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2023
Last Update Date	:	04/27/2023

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