MEDICARE: DOCTORS MEDICAL PHARMACY LLC

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	5301009084	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2119517	OTHER		PK

General Provider Information

NPI Number	:	1811139496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTORS MEDICAL PHARMACY LLC

Provider Business Mailing Address
First Line	:	3169 WOODWARD AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2723
Country	:	US
Telephone Number	:	313-832-4810
Fax Number	:	313-832-4812

Provider Business Practice Location Address
First Line	:	3169 WOODWARD AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2723
Country	:	US
Telephone Number	:	313-832-4810
Fax Number	:	313-832-4812

Authorized Official
Title or Position	:	OWNER
Name	:	MOHAMED SOHOUBAH
Credential	:	RPH
Telephone Number	:	248-663-3380

Provider Enumeration Date	:	03/30/2009
Last Update Date	:	03/16/2017

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