Provider Demographics
NPI:1962158089
Name:AL-HAYDER, ALI (PHARMD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:AL-HAYDER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29957 ELMWOOD ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2346
Mailing Address - Country:US
Mailing Address - Phone:313-445-0210
Mailing Address - Fax:
Practice Address - Street 1:20292 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2002
Practice Address - Country:US
Practice Address - Phone:248-987-2888
Practice Address - Fax:248-987-4945
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302414012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist