Healthcare Provider Details

I. General information

NPI: 1477036655
Provider Name (Legal Business Name): DALIA ELGOHARY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5016 S MARTIN LUTHER KING
LANSING MI
48910
US

IV. Provider business mailing address

5016 S MARTIN LUTHER KING JR BLVD
LANSING MI
48910-6126
US

V. Phone/Fax

Practice location:
  • Phone: 517-580-0991
  • Fax:
Mailing address:
  • Phone: 517-580-0991
  • Fax: 517-580-0992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302041723
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: