Active NPI
Jihad H Beydoun
- Pharmacist
- Southgate, MI
National Provider Identifier
1659810323
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302028248
- Practice address
- 15830 Fort St
Suite 5
Southgate, MI 48195-1367 - Phone
- (734) 282-1940
- NPI assigned
- Feb 15, 2017
- Sex
- Male
- Sole proprietor
- No
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 | 5302028248 | MI | Primary |
Addresses
Primary practice location
15830 Fort St
Suite 5
Southgate, MI 48195-1367
Mailing address
6433 Oakman Blvd
Dearborn, MI 48126-2313
Phone (313) 421-3352
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2367616 | Medicaid | MI |
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 |
|---|---|---|---|
| 5302028248 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Belavista Drugs Inc | Current | Accepting new patients | |
| Belavista Drugs | Pharmacist | Current | Accepting new patients |
Locations
15830 Fort St
Ste 5
Southgate, MI 48195
Phone (734) 282-1940
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Southgate, MI
- NPI 1619019957
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1487116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487116800000",
"number": "1659810323",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6433 OAKMAN BLVD",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481262313",
"telephone_number": "313-421-3352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15830 FORT ST",
"address_2": "SUITE 5",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "481951367",
"telephone_number": "734-282-1940"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEYDOUN",
"first_name": "JIHAD",
"middle_name": "H",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-02-15",
"last_updated": "2017-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302028248",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2367616",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southgate, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.