Healthcare Provider Details

I. General information

NPI: 1154611580
Provider Name (Legal Business Name): MASOOD MAGHSOODI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 W SAGINAW ST
LANSING MI
48915-1966
US

IV. Provider business mailing address

4489 WAUSAU RD
OKEMOS MI
48864-2741
US

V. Phone/Fax

Practice location:
  • Phone: 517-374-6103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302411325
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: