Healthcare Provider Details

I. General information

NPI: 1487065249
Provider Name (Legal Business Name): MOHAMAD HAMADE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31450 VAN BORN RD
WAYNE MI
48184-2631
US

IV. Provider business mailing address

31450 VAN BORN RD
WAYNE MI
48184-2698
US

V. Phone/Fax

Practice location:
  • Phone: 734-728-4295
  • Fax: 734-728-4375
Mailing address:
  • Phone: 734-728-4295
  • Fax: 734-728-4375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302035451
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS015549
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: