MEDICARE: PHARMACEUTICAL MEDICAL CONSULTING PLLC

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	291U00000X	Clinical Medical Laboratory	291U00000X	MI

General Provider Information

NPI Number	:	1427503101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACEUTICAL MEDICAL CONSULTING PLLC

Provider Business Mailing Address
First Line	:	4245 S BEECH DALY ST
Second Line	:	STE. 201
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-1576
Country	:	US
Telephone Number	:	248-890-6515
Fax Number	:

Provider Business Practice Location Address
First Line	:	4245 S BEECH DALY ST
Second Line	:	STE. 201
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-1576
Country	:	US
Telephone Number	:	248-890-6515
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. CHARISE VALENTINE
Credential	:	M.D.
Telephone Number	:	248-890-6515

Provider Enumeration Date	:	08/23/2016
Last Update Date	:	05/12/2017

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