MEDICARE: ELISSAR HAMMOUD

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	5302029127	MI

General Provider Information

NPI Number	:	1538692769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISSAR HAMMOUD

Provider Business Mailing Address
First Line	:	819 INKSTER RD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-4118
Country	:	US
Telephone Number	:	313-574-3282
Fax Number	:	734-261-0404

Provider Business Practice Location Address
First Line	:	819 INKSTER RD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-4118
Country	:	US
Telephone Number	:	313-574-3282
Fax Number	:	734-261-0404

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

Provider Enumeration Date	:	04/05/2017
Last Update Date	:	04/05/2017

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Directions to “ ELISSAR HAMMOUD ” Practice Location

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