Healthcare Provider Details

I. General information

NPI: 1063327617
Provider Name (Legal Business Name): MOHAMAD HAMMOUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10011 W MCNICHOLS RD
DETROIT MI
48221-2453
US

IV. Provider business mailing address

6947 CRONIN DR
DEARBORN HEIGHTS MI
48127-1963
US

V. Phone/Fax

Practice location:
  • Phone: 313-340-2893
  • Fax:
Mailing address:
  • Phone: 313-395-9256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302419146
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: