=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871167239
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NASHWAN ALGUMAEI RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2021
-----------------------------------------------------
Last Update Date | 05/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1549 HOLMES RD
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48198-4147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-340-6050
-----------------------------------------------------
Fax | 734-544-1337
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1549 HOLMES RD
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48198-4147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-340-6050
-----------------------------------------------------
Fax | 734-340-6050
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 5302041123
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------