Healthcare Provider Details

I. General information

NPI: 1700461100
Provider Name (Legal Business Name): BINGHAM PHARMACY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13320 W WARREN AVE STE B
DEARBORN MI
48126-1417
US

IV. Provider business mailing address

13320 W WARREN AVE STE B
DEARBORN MI
48126-1417
US

V. Phone/Fax

Practice location:
  • Phone: 313-581-4451
  • Fax: 313-581-7560
Mailing address:
  • Phone: 313-581-4451
  • Fax: 313-581-7560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MOHAMED H. AYAD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 954-496-1430