Provider Demographics
NPI:1104440395
Name:MAKKINEJAD, ARAM J
Entity type:Individual
Prefix:
First Name:ARAM
Middle Name:J
Last Name:MAKKINEJAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 HARTLAND DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5011
Mailing Address - Country:US
Mailing Address - Phone:248-525-1757
Mailing Address - Fax:
Practice Address - Street 1:2046 BLACK RIVER ST STE 2
Practice Address - Street 2:
Practice Address - City:DECKERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48427-9448
Practice Address - Country:US
Practice Address - Phone:810-376-8070
Practice Address - Fax:810-376-8071
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist