Provider Demographics
NPI:1124385679
Name:MUSTAPHA, MUSSA DIB (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MUSSA
Middle Name:DIB
Last Name:MUSTAPHA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7621 CHASE RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1001
Mailing Address - Country:US
Mailing Address - Phone:313-584-7621
Mailing Address - Fax:
Practice Address - Street 1:7621 CHASE RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1001
Practice Address - Country:US
Practice Address - Phone:313-584-7621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist