Active NPI
Bederadine Mawari
- Pharmacist
- Dearborn, MI
National Provider Identifier
1083481832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302415575
- Practice address
- 15120 Michigan Ave # C
Dearborn, MI 48126-3768 - Phone
- (313) 733-8034
- NPI assigned
- Dec 11, 2023
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302415575 | MI | Primary |
Addresses
Primary practice location
15120 Michigan Ave # C
Dearborn, MI 48126-3768
Mailing address
3322 Edsel St
Dearborn, MI 48120-1433
Phone (313) 491-9365
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302415575 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1702252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702252800000",
"number": "1083481832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3322 EDSEL ST",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481201433",
"telephone_number": "313-491-9365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15120 MICHIGAN AVE # C",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481263768",
"telephone_number": "313-733-8034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAWARI",
"first_name": "BEDERADINE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-12-11",
"last_updated": "2023-12-11",
"certification_date": "2023-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302415575",
"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 Dec 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.