Provider Demographics
NPI:1386469054
Name:MOHAMED, AHMED HATEM AHMED
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:HATEM AHMED
Last Name:MOHAMED
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 1:44547 BAYVIEW AVE APT 8112
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6278
Mailing Address - Country:US
Mailing Address - Phone:586-280-4313
Mailing Address - Fax:
Practice Address - Street 1:29176 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-6764
Practice Address - Country:US
Practice Address - Phone:586-467-0258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302416957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist