Healthcare Provider Details

I. General information

NPI: 1144140179
Provider Name (Legal Business Name): WANDA HAMMOUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48035 RAVELLO CT
NORTHVILLE MI
48167-9822
US

IV. Provider business mailing address

48035 RAVELLO CT
NORTHVILLE MI
48167-9822
US

V. Phone/Fax

Practice location:
  • Phone: 248-974-2655
  • Fax:
Mailing address:
  • Phone: 248-974-2655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number53002027685
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: