Provider Demographics
NPI:1083998066
Name:MOUGHNI-AYAD, WAFA A (RPH)
Entity Type:Individual
Prefix:MRS
First Name:WAFA
Middle Name:A
Last Name:MOUGHNI-AYAD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20090 GODDARD RD.
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4313
Mailing Address - Country:US
Mailing Address - Phone:313-299-1584
Mailing Address - Fax:
Practice Address - Street 1:20090 GODDARD RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4313
Practice Address - Country:US
Practice Address - Phone:313-299-1584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist