MEDICARE: MALEK MOHAMAD YASSINE

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	5302413390	MI

General Provider Information

NPI Number	:	1518638824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALEK MOHAMAD YASSINE

Provider Business Mailing Address
First Line	:	635 NORBORNE AVE
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-3761
Country	:	US
Telephone Number	:	313-977-6347
Fax Number	:

Provider Business Practice Location Address
First Line	:	635 NORBORNE AVE
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-3761
Country	:	US
Telephone Number	:	313-977-6347
Fax Number	:

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

Provider Enumeration Date	:	09/26/2021
Last Update Date	:	12/05/2022

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