Provider Demographics
NPI:1285390443
Name:GHANNOUM, TAHA
Entity type:Individual
Prefix:
First Name:TAHA
Middle Name:
Last Name:GHANNOUM
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 1:2201 TYLER RD
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-1705
Mailing Address - Country:US
Mailing Address - Phone:205-823-1832
Mailing Address - Fax:
Practice Address - Street 1:2201 TYLER RD
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-1705
Practice Address - Country:US
Practice Address - Phone:205-823-1832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist