Active NPI
Azam Mohsen Mesleh
- Community/Retail Pharmacy
- Dearborn, MI
National Provider Identifier
1023621190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Practice address
- 6811 Theisen St
Dearborn, MI 48126-1927 - Phone
- (313) 329-8699
- NPI assigned
- Aug 28, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
6811 Theisen St
Dearborn, MI 48126-1927
Mailing address
1538 Charleston Ave
Huntington, WV 25701
Phone (304) 696-7302
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598572800000",
"number": "1023621190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1538 CHARLESTON AVE",
"city": "HUNTINGTON",
"state": "WV",
"postal_code": "25701",
"telephone_number": "304-696-7302"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6811 THEISEN ST",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481261927",
"telephone_number": "313-329-8699"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MESLEH",
"first_name": "AZAM",
"middle_name": "MOHSEN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-08-28",
"last_updated": "2020-08-28",
"certification_date": "2020-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.