Healthcare Provider Details

I. General information

NPI: 1023239381
Provider Name (Legal Business Name): AHMED A HASSAN RPH, CGP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 HORSESHOE CIR APT # 205
ANN ARBOR MI
48108-2823
US

IV. Provider business mailing address

1226 HORSESHOE CIR APT # 205
ANN ARBOR MI
48108-2823
US

V. Phone/Fax

Practice location:
  • Phone: 630-242-1705
  • Fax: 630-242-1705
Mailing address:
  • Phone: 630-242-1705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number5302036163
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: