MEDICARE: RENE ABDALLAH EID R.PH.

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	5302029449	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5302029449	OTHER	MI	STATE LICENCE NUMBER

General Provider Information

NPI Number	:	1558430744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENE ABDALLAH EID R.PH.

Provider Business Mailing Address
First Line	:	3030 ALDERDALE DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-1727
Country	:	US
Telephone Number	:	586-979-7645
Fax Number	:	313-868-0941

Provider Business Practice Location Address
First Line	:	2645 W DAVISON
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48238-3443
Country	:	US
Telephone Number	:	313-868-0940
Fax Number	:	313-868-0941

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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