Healthcare Provider Details

I. General information

NPI: 1427861376
Provider Name (Legal Business Name): MOJTABA KHENIFAR PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27000 TELEGRAPH RD
FLAT ROCK MI
48134-1640
US

IV. Provider business mailing address

27000 TELEGRAPH RD
FLAT ROCK MI
48134-1640
US

V. Phone/Fax

Practice location:
  • Phone: 734-782-2438
  • Fax:
Mailing address:
  • Phone: 734-782-2438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302417023
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: