Healthcare Provider Details

I. General information

NPI: 1245973353
Provider Name (Legal Business Name): MOHAMMED SAIFUL ISLAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2022
Last Update Date: 04/16/2022
Certification Date: 04/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E STATE ST
CASSOPOLIS MI
49031-1328
US

IV. Provider business mailing address

987 BANWELL RD
WINDSOR ONTARIO
N8P 1J3
CA

V. Phone/Fax

Practice location:
  • Phone: 269-445-5369
  • Fax: 269-445-5369
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302035943
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: