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General NPI Number Information
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NPI Number | 1265128029
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Entity Type | Individual
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Provider Name | WISSAM GHOZAYEL PHARM D.
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Gender | Male
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Dates
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Enumeration Date | 04/14/2023
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Last Update Date | 04/14/2023
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Provider Practice Location Address
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Address Line | 3145 W CLARK RD STE 201
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City | YPSILANTI
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State | MI
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Zip | 48197-1120
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Country | US
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Telephone | 734-470-0700
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Fax | 734-470-0777
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Provider Business Mailing Address
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Address Line | 33685 ORANGELAWN ST
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City | LIVONIA
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State | MI
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Zip | 48150-2631
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Country | US
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Telephone | 313-670-7151
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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 | 5302041499
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License Number State | MI
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