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NPI Code Detail

MEDICARE: EYAS MUALLA

MEDICARE: EYAS MUALLA
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
1183500000XPharmacist5302042372MI

General Provider Information

NPI Number : 1760874754
Entity Type Code : Individual
Provider Name (Legal Business Name) : EYAS MUALLA
Provider Business Mailing Address
First Line : 2613 LAKE PINE DR
Second Line : APT 65
City : SAINT JOSEPH
State : MI
Zip : 49085-8206
Country : US
Telephone Number : 630-660-6328
Fax Number :
Provider Business Practice Location Address
First Line : 1260 HILLTOP RD
Second Line :
City : SAINT JOSEPH
State : MI
Zip : 49085-2839
Country : US
Telephone Number : 269-983-0315
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2015
Last Update Date : 02/27/2015

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Directions to “ EYAS MUALLA ” Practice Location

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