MEDICARE: HADI I HOBALLAH

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	5302413958	MI

General Provider Information

NPI Number	:	1801551635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HADI I HOBALLAH

Provider Business Mailing Address
First Line	:	7238 BARRIE ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-1322
Country	:	US
Telephone Number	:	313-415-2221
Fax Number	:

Provider Business Practice Location Address
First Line	:	30020 GRAND RIVER AVE
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-4722
Country	:	US
Telephone Number	:	248-477-1467
Fax Number	:

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

Provider Enumeration Date	:	11/05/2021
Last Update Date	:	11/05/2021

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Directions to “ HADI I HOBALLAH ” Practice Location

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