Boby Abraham
Individual provider Active NPI Pharmacist · Southfield, MI
NPI 1013291970 · NPPES record last updated Oct 10, 2011
Key facts
- NPI
- 1013291970
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 5302036880 (MI)
- Practice address
- 23111 Lahser Road
Walgreens
Southfield, MI 48034 - Phone
- (248) 945-9216
- NPI assigned
- Oct 10, 2011
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302036880 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302036880 | MI | Yes |
Addresses
Primary practice location
23111 Lahser Road
Walgreens
Southfield, MI 48034
Mailing address
1075 Beaver Run
Troy, MI 48083-5458
Phone (586) 588-7724
Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.