MEDICARE: MR. TARICK IQAL

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	5302028631	MI

General Provider Information

NPI Number	:	1487743415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TARICK IQAL

Provider Business Mailing Address
First Line	:	39729 GOLFVIEW DR
Second Line	:
City	:	NORTHVILLE
State	:	MI
Zip	:	48167-3971
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25853 FORD RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2934
Country	:	US
Telephone Number	:	313-562-7392
Fax Number	:

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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