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NPI Code Detail

MEDICARE: PARK MEDICAL PHARMACY INC

MEDICARE: PARK MEDICAL PHARMACY 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
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail Pharmacy5301009761MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12376095OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1508133968
Entity Type Code : Organization
Provider Name (Legal Business Name) : PARK MEDICAL PHARMACY INC
Provider Business Mailing Address
First Line : 20720 PLYMOUTH RD
Second Line :
City : DETROIT
State : MI
Zip : 48228-1275
Country : US
Telephone Number : 313-288-2203
Fax Number :
Provider Business Practice Location Address
First Line : 20720 PLYMOUTH RD
Second Line :
City : DETROIT
State : MI
Zip : 48228-1275
Country : US
Telephone Number : 313-288-2203
Fax Number :
Authorized Official
Title or Position : PHARMACIST
Name : MAITHAM ALSHARIFI
Credential :
Telephone Number : 313-651-5887
Provider Enumeration Date : 11/29/2011
Last Update Date : 12/16/2014

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Directions to “PARK MEDICAL PHARMACY INC ” Practice Location

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