Healthcare Provider Details

I. General information

NPI: 1205466778
Provider Name (Legal Business Name): MOHAMED GELAN PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 N STATE RD
DAVISON MI
48423-1311
US

IV. Provider business mailing address

1635 SALINA ST
DEARBORN MI
48120-1605
US

V. Phone/Fax

Practice location:
  • Phone: 810-658-0527
  • Fax:
Mailing address:
  • Phone: 313-434-5098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302412146
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: