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NPI Code Detail

MEDICARE: DENA JADALLAH

MEDICARE: DENA JADALLAH
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
13336C0003XCommunity/Retail Pharmacy5302413156MI

General Provider Information

NPI Number : 1487242806
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENA JADALLAH
Provider Business Mailing Address
First Line : 20054 DOVETAIL DR
Second Line :
City : BROWNSTOWN TWP
State : MI
Zip : 48183-1182
Country : US
Telephone Number : 313-523-1990
Fax Number :
Provider Business Practice Location Address
First Line : 5709 S TELEGRAPH RD
Second Line :
City : DEARBORN HEIGHTS
State : MI
Zip : 48125-2025
Country : US
Telephone Number : 313-292-1599
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2021
Last Update Date : 01/06/2021

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Directions to “ DENA JADALLAH ” Practice Location

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