MEDICARE: AMIRA K ATRISSI 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	5302039027	MI

General Provider Information

NPI Number	:	1477998805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIRA K ATRISSI RPH

Provider Business Mailing Address
First Line	:	23874 KEAN ST
Second Line	:	SUITE 120
City	:	DEARBORN
State	:	MI
Zip	:	48124-1804
Country	:	US
Telephone Number	:	313-498-7464
Fax Number	:	734-722-4355

Provider Business Practice Location Address
First Line	:	23874 KEAN ST
Second Line	:	SUITE 120
City	:	DEARBORN
State	:	MI
Zip	:	48124-1804
Country	:	US
Telephone Number	:	313-498-7464
Fax Number	:	734-722-4355

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

Provider Enumeration Date	:	04/29/2013
Last Update Date	:	04/29/2013

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Directions to “ AMIRA K ATRISSI RPH” Practice Location

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