Mediaid Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

MEDIAID PHARMACY

Practice address

11828 Joseph Campau St
Hamtramck, MI 48212-3049

Phone

(313) 409-2192

NPI assigned

Oct 13, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mohammed Mustafizur Rahman, PHARMDNPI 1003648387

Title

Owner

Phone

(313) 409-2192

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mohammed Mustafizur Rahman

  • Pharmacist
  • Grand Ledge, MI
  • NPI 1003648387
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1760313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760313600000",
    "number": "1548136195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11828 JOSEPH CAMPAU ST",
            "city": "HAMTRAMCK",
            "state": "MI",
            "postal_code": "482123049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11828 JOSEPH CAMPAU ST",
            "city": "HAMTRAMCK",
            "state": "MI",
            "postal_code": "482123049",
            "telephone_number": "313-409-2192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDIAID PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-13",
        "last_updated": "2025-10-13",
        "certification_date": "2025-10-12",
        "status": "A",
        "authorized_official_last_name": "RAHMAN",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_middle_name": "MUSTAFIZUR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-409-2192",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Retail Pharmacy in Hamtramck, MI
• Providers in Hamtramck, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.