MEDICARE: HUSSEIN MAHMOUD SABBAGH 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	5302041588	MI

General Provider Information

NPI Number	:	1205326352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUSSEIN MAHMOUD SABBAGH RPH

Provider Business Mailing Address
First Line	:	5271 TERNES ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-4625
Country	:	US
Telephone Number	:	313-516-5006
Fax Number	:

Provider Business Practice Location Address
First Line	:	4515 S TELEGRAPH RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-1934
Country	:	US
Telephone Number	:	313-438-6222
Fax Number	:

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

Provider Enumeration Date	:	05/15/2018
Last Update Date	:	05/15/2018

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