Mahdi Moustapha Bazzoun, RPH
Individual provider Active NPI Pharmacist · Howell, MI
NPI 1497439897 · NPPES record last updated Jun 14, 2023
Key facts
- NPI
- 1497439897
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 5302415168 (MI)
- Practice address
- 2235 E Grand River Ave
Howell, MI 48843-2479 - Phone
- (517) 548-2401
- NPI assigned
- Jun 14, 2023
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302415168 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MB Wellness Pharmacy | Current | Accepting new patients | |
| Woodward Detroit CVS, L.L.C. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302415168 | MI | Yes |
Addresses
Primary practice location
2235 E Grand River Ave
Howell, MI 48843-2479
Mailing address
5920 Centralia St
Dearborn Heights, MI 48127-2933
Other providers in Howell, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.