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General NPI Number Information
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NPI Number | 1063150696
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Entity Type | Individual
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Provider Name | MARK MANSOUR SALEH PHARMD
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Gender | Male
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 4433 MILLER RD
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City | FLINT
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State | MI
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Zip | 48507-1123
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Country | US
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Telephone | 810-733-6653
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Fax |
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Provider Business Mailing Address
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Address Line | 1960 BLUE GRASS DR
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City | ROCHESTER HILLS
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State | MI
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Zip | 48306-3228
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Country | US
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Telephone | 248-520-0526
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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 | 5302414151
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License Number State | MI
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