MEDICARE: MOHAMMAD BAKDALEYEH 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	5302035964	MI

General Provider Information

NPI Number	:	1699306381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMAD BAKDALEYEH PHARMD

Provider Business Mailing Address
First Line	:	10501 HIGHLAND RD
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-2145
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10501 HIGHLAND RD
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-2145
Country	:	US
Telephone Number	:	248-698-8876
Fax Number	:

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

Provider Enumeration Date	:	01/31/2020
Last Update Date	:	01/31/2020

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