MEDICARE: ALI JAMAL SABBAGH PHARM D

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	5302040042	MI

General Provider Information

NPI Number	:	1386994242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI JAMAL SABBAGH PHARM D

Provider Business Mailing Address
First Line	:	6336 JONATHON ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-2266
Country	:	US
Telephone Number	:	313-779-3990
Fax Number	:

Provider Business Practice Location Address
First Line	:	31415 FORD RD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-1821
Country	:	US
Telephone Number	:	734-367-0962
Fax Number	:

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

Provider Enumeration Date	:	09/18/2012
Last Update Date	:	09/18/2012

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