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NPI Code Detail

MEDICARE: MR. AHMED GOMAA

MEDICARE: MR. AHMED GOMAA
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
1183500000XPharmacist5302042561MI

General Provider Information

NPI Number : 1902267149
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. AHMED GOMAA
Provider Business Mailing Address
First Line : 111 LAKE VILLAGE BLVD
Second Line : APT 201
City : DEARBORN
State : MI
Zip : 48120-1681
Country : US
Telephone Number : 201-675-2289
Fax Number :
Provider Business Practice Location Address
First Line : 25700 FORD RD
Second Line :
City : DEARBORN HEIGHTS
State : MI
Zip : 48127-3026
Country : US
Telephone Number : 313-359-9640
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2016
Last Update Date : 03/16/2016

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