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General NPI Number Information
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NPI Number | 1003215781
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Entity Type | Individual
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Provider Name | MOUNA AMIRA
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Gender | Female
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Dates
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Enumeration Date | 08/18/2014
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Last Update Date | 08/18/2014
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Provider Practice Location Address
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Address Line | 37165 S GROESBECK HWY
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City | CLINTON TWP
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State | MI
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Zip | 48036-2315
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Country | US
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Telephone | 248-526-1869
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 71275
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-0275
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Country | US
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Telephone | 248-526-1869
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302039786
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License Number State | MI
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