MEDICARE: ATLAS 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1457420986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLAS PHARMACY INC.

Provider Business Mailing Address
First Line	:	2645 W DAVISON
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48238-3443
Country	:	US
Telephone Number	:	313-868-0940
Fax Number	:	313-868-0941

Provider Business Practice Location Address
First Line	:	2645 W. DAVISON
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48238-3443
Country	:	US
Telephone Number	:	313-868-0940
Fax Number	:	313-868-0941

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RENE ABDALLAH EID
Credential	:	RPH
Telephone Number	:	313-868-0940

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	11/12/2009

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