Healthcare Provider Details

I. General information

NPI: 1366078735
Provider Name (Legal Business Name): ALI CHEAIB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 CHERRY ST
TOLEDO OH
43608-2911
US

IV. Provider business mailing address

1028 KINDER RD
TOLEDO OH
43615-6814
US

V. Phone/Fax

Practice location:
  • Phone: 419-255-9524
  • Fax:
Mailing address:
  • Phone: 567-218-6083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03438604
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: