Healthcare Provider Details

I. General information

NPI: 1720940554
Provider Name (Legal Business Name): ABDULHAKEEM MOHAMED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 JOSEPH CAMPAU ST
HAMTRAMCK MI
48212-3434
US

IV. Provider business mailing address

5494 WILLIAMSON ST
DEARBORN MI
48126-3172
US

V. Phone/Fax

Practice location:
  • Phone: 313-874-5300
  • Fax:
Mailing address:
  • Phone: 313-335-4797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302418355
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: