Healthcare Provider Details

I. General information

NPI: 1801902937
Provider Name (Legal Business Name): ALI RASHID ELHASAN R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18287 ALLEN RD
MELVINDALE MI
48122-1513
US

IV. Provider business mailing address

18287 ALLEN RD
MELVINDALE MI
48122-1513
US

V. Phone/Fax

Practice location:
  • Phone: 313-386-0830
  • Fax: 313-386-0907
Mailing address:
  • Phone: 313-386-0830
  • Fax: 313-386-0907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302028620
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: