Active NPI
Mohamad Haissam Ghazzaoui, PHARMD
- Pharmacist
- Dearborn, MI
National Provider Identifier
1972127843
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302415557
- Practice address
- 14716 W Warren Ave
Dearborn, MI 48126-1347 - Phone
- (313) 582-1350
- NPI assigned
- Jun 5, 2020
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 5303018068 | MI | |
| Student in an Organized Health Care Education/Training Program | 390200000X | 5351016280 | MI | |
| Pharmacist | 183500000X | 5302415557 | MI | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X | 9672 | NE |
Addresses
Primary practice location
14716 W Warren Ave
Dearborn, MI 48126-1347
Mailing address
14716 W Warren Ave
Dearborn, MI 48126-1347
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 |
|---|---|---|---|
| 9672 | NE | MD | Mental Health Counselor |
| 5302415557 | MI | MD | Pharmacist |
| 5303018068 | MI | MD | Pharmacy Technician |
| 5351016280 | MI | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694736000000",
"number": "1972127843",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14716 W WARREN AVE",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481261347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14716 W WARREN AVE",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481261347",
"telephone_number": "313-582-1350"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHAZZAOUI",
"first_name": "MOHAMAD",
"middle_name": "HAISSAM",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-06-05",
"last_updated": "2023-09-15",
"certification_date": "2023-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "MI",
"license": "5303018068",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MI",
"license": "5351016280",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302415557",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NE",
"license": "9672",
"primary": false
}
],
"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 Sep 15, 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.