MEDICARE: DR. ALI JIHAD KHOCHEICHE PHARMD, MBA

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	5302043664	MI

General Provider Information

NPI Number	:	1790308831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALI JIHAD KHOCHEICHE PHARMD, MBA

Provider Business Mailing Address
First Line	:	24739 EMERSON ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-1537
Country	:	US
Telephone Number	:	313-523-1633
Fax Number	:

Provider Business Practice Location Address
First Line	:	1444 MICHIGAN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48216-1324
Country	:	US
Telephone Number	:	313-523-1633
Fax Number	:

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

Provider Enumeration Date	:	05/23/2020
Last Update Date	:	04/19/2022

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