MEDICARE: COMPREHENSIVE PHARMACY SOLUTIONS, PLLC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	5301008561	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2369305	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790832848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE PHARMACY SOLUTIONS, PLLC

Provider Business Mailing Address
First Line	:	8024 N MIDDLEBELT RD
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48185-1808
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8024 N MIDDLEBELT RD
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48185-1808
Country	:	US
Telephone Number	:	734-525-0011
Fax Number	:	734-525-1900

Authorized Official
Title or Position	:	OWNER/PIC
Name	:	FADI FARDOUS
Credential	:
Telephone Number	:	734-525-0011

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	03/27/2009

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