Provider Demographics
NPI:1013540426
Name:ABUEIDA, AIMAN (BACHELOR IN PHARMACY)
Entity Type:Individual
Prefix:
First Name:AIMAN
Middle Name:
Last Name:ABUEIDA
Suffix:
Gender:M
Credentials:BACHELOR IN PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6907 BARRIE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1773
Mailing Address - Country:US
Mailing Address - Phone:313-523-5334
Mailing Address - Fax:313-982-3221
Practice Address - Street 1:17000 EXECUTIVE PLAZA DR STE 201
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2793
Practice Address - Country:US
Practice Address - Phone:313-982-3220
Practice Address - Fax:313-982-3221
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020290591835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302029059OtherBOARD OF PHARMACY