Healthcare Provider Details

I. General information

NPI: 1649756594
Provider Name (Legal Business Name): MOHAMED TAHER ABBAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 HIGHLAND RD
WATERFORD MI
48327-1915
US

IV. Provider business mailing address

2652 EVALINE ST
HAMTRAMCK MI
48212-3214
US

V. Phone/Fax

Practice location:
  • Phone: 248-673-4324
  • Fax:
Mailing address:
  • Phone: 313-452-1217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302042569
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302042569
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: