Healthcare Provider Details

I. General information

NPI: 1558646778
Provider Name (Legal Business Name): MR. ASHRAF ZAKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9273 LAKE DR
CIRCLE PINES MN
55014-3764
US

IV. Provider business mailing address

3042 92ND LN NE
BLAINE MN
55449-5612
US

V. Phone/Fax

Practice location:
  • Phone: 763-783-7005
  • Fax:
Mailing address:
  • Phone: 763-221-4247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number115783
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: