MEDICARE: YARA KANNAB AIDA RPH

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	5302418567	MI

General Provider Information

NPI Number	:	1467384172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YARA KANNAB AIDA RPH

Provider Business Mailing Address
First Line	:	4108 GREENSBORO DR
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48085
Country	:	US
Telephone Number	:	248-567-9342
Fax Number	:

Provider Business Practice Location Address
First Line	:	5250 AUTO CLUB DR SUIT 200
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126
Country	:	US
Telephone Number	:	313-203-5300
Fax Number	:

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

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	06/08/2026

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