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General NPI Number Information
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NPI Number | 1477216497
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Entity Type | Individual
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Provider Name | SIRAJ DGHAILY RPH
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Gender | Male
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Dates
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Enumeration Date | 10/17/2021
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Last Update Date | 10/17/2021
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Provider Practice Location Address
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Address Line | 6501 N WAYNE RD
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City | WESTLAND
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State | MI
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Zip | 48185-2713
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Country | US
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Telephone | 734-729-9210
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Fax |
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Provider Business Mailing Address
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Address Line | 29220 BEECHNUT ST
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City | INKSTER
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State | MI
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Zip | 48141-1192
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Country | US
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Telephone | 786-922-3031
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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 | 5302413838
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License Number State | MI
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