MEDICARE: MOJTABA KHENIFAR PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302417023	MI

General Provider Information

NPI Number	:	1427861376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOJTABA KHENIFAR PHARMD

Provider Business Mailing Address
First Line	:	27000 TELEGRAPH RD
Second Line	:
City	:	FLAT ROCK
State	:	MI
Zip	:	48134-1640
Country	:	US
Telephone Number	:	734-782-2438
Fax Number	:

Provider Business Practice Location Address
First Line	:	27000 TELEGRAPH RD
Second Line	:
City	:	FLAT ROCK
State	:	MI
Zip	:	48134-1640
Country	:	US
Telephone Number	:	734-782-2438
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2025
Last Update Date	:	01/27/2025

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