Healthcare Provider Details

I. General information

NPI: 1578525416
Provider Name (Legal Business Name): AHAB ELMADHOUN PHARM.D, MBA, BCPS,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 TELEGRAPH RD
TAYLOR MI
48180-3330
US

IV. Provider business mailing address

2642 THE CROSSINGS LN
CANTON MI
48188-2573
US

V. Phone/Fax

Practice location:
  • Phone: 313-295-5250
  • Fax:
Mailing address:
  • Phone: 313-574-0165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302032493
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: