MEDICARE: MONROE STREET PHARMACY, INC.

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	183500000X	MI
2	3336C0003X	Community/Retail Pharmacy	5301006022	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	540H212390	OTHER	MI	BCBSM DME
2	2352691	OTHER	MI	NABP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427076611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONROE STREET PHARMACY, INC.

Provider Business Mailing Address
First Line	:	2507 MONROE ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-3013
Country	:	US
Telephone Number	:	313-274-9141
Fax Number	:	313-274-9182

Provider Business Practice Location Address
First Line	:	2507 MONROE ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-3013
Country	:	US
Telephone Number	:	313-274-9141
Fax Number	:	313-274-9182

Authorized Official
Title or Position	:	CHIEF PHARMACIST
Name	:	MR. ALLIE HAMOOD
Credential	:	RPH.
Telephone Number	:	313-274-9141

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	02/25/2016

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