Healthcare Provider Details

I. General information

NPI: 1154867232
Provider Name (Legal Business Name): DARAOUN MASHRAH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35101 E MICHIGAN AVE
WAYNE MI
48184-1660
US

IV. Provider business mailing address

7830 CALHOUN ST
DEARBORN MI
48126-1151
US

V. Phone/Fax

Practice location:
  • Phone: 734-729-7810
  • Fax:
Mailing address:
  • Phone: 313-421-7295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302041929
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: