MEDICARE: MR. GHASSAN YAZBECK 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	5302026062	MI

General Provider Information

NPI Number	:	1710062922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GHASSAN YAZBECK RPH

Provider Business Mailing Address
First Line	:	2676 W GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48208-1237
Country	:	US
Telephone Number	:	313-871-3285
Fax Number	:	313-871-0788

Provider Business Practice Location Address
First Line	:	2676 W GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48208-1237
Country	:	US
Telephone Number	:	313-871-3285
Fax Number	:	313-871-0788

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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