MEDICARE: TRI DALY DRUGS 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	5301002211	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2307583	OTHER		OTHER ID NUMBER

General Provider Information

NPI Number	:	1477661833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI DALY DRUGS INC

Provider Business Mailing Address
First Line	:	43155 W 9 MILE RD
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48375-4190
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25853 FORD RD
Second Line	:
City	:	DEARBORN HTS
State	:	MI
Zip	:	48127-2934
Country	:	US
Telephone Number	:	313-562-7358
Fax Number	:	313-562-1151

Authorized Official
Title or Position	:	MANAGER PHARMACY SERVICES
Name	:	STEPHEN GRAHAM
Credential	:
Telephone Number	:	248-348-1570

Provider Enumeration Date	:	08/27/2006
Last Update Date	:	04/15/2008

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Directions to “TRI DALY DRUGS INC ” Practice Location

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