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General NPI Number Information
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NPI Number | 1750866042
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Entity Type | Individual
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Provider Name | HUSSEIN CHAMMOUT PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/02/2018
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Last Update Date | 10/02/2018
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Provider Practice Location Address
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Address Line | 15617 W MCNICHOLS RD
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City | DETROIT
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State | MI
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Zip | 48235-3541
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Country | US
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Telephone | 313-544-7144
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Fax | 313-544-7147
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Provider Business Mailing Address
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Address Line | 26257 SIMONE ST
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-3367
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Country | US
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Telephone | 313-485-7500
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Fax | 313-544-7147
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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 | 5302038978
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License Number State | MI
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