Active NPI
Esra Ahhmed Mansour, PHARMD
- Pharmacist
- Troy, MI
National Provider Identifier
1356972244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302043793
- Practice address
- 125 E Long Lake Rd
Troy, MI 48085-5524 - Phone
- (248) 879-9114
- NPI assigned
- Jan 29, 2020
- Last updated
- Jan 29, 2020
- Sex
- Female
- 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 | 5302043793 | MI | Primary |
Addresses
Primary practice location
125 E Long Lake Rd
Troy, MI 48085-5524
Mailing address
125 E Long Lake Rd
Troy, MI 48085-5524
Phone (248) 879-9114
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302043793 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Woodward Detroit CVS, L.L.C. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580256000000",
"number": "1356972244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 E LONG LAKE RD",
"city": "TROY",
"state": "MI",
"postal_code": "480855524",
"telephone_number": "248-879-9114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 E LONG LAKE RD",
"city": "TROY",
"state": "MI",
"postal_code": "480855524",
"telephone_number": "248-879-9114"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANSOUR",
"first_name": "ESRA",
"middle_name": "AHHMED",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-01-29",
"last_updated": "2020-01-29",
"certification_date": "2020-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302043793",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Troy, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 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.