Healthcare Provider Details

I. General information

NPI: 1295519122
Provider Name (Legal Business Name): MANHAL SAIF BEBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 S OLD WOODWARD AVE
BIRMINGHAM MI
48009-6610
US

IV. Provider business mailing address

55490 APPLE LN
SHELBY TOWNSHIP MI
48316-5334
US

V. Phone/Fax

Practice location:
  • Phone: 248-647-0790
  • Fax:
Mailing address:
  • Phone: 586-382-3611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302415497
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: