Provider Demographics
NPI:1235992249
Name:HAMO, MILAD MANSOOR
Entity Type:Individual
Prefix:
First Name:MILAD
Middle Name:MANSOOR
Last Name:HAMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4538 NORTHRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-1397
Mailing Address - Country:US
Mailing Address - Phone:248-444-0443
Mailing Address - Fax:
Practice Address - Street 1:4538 NORTHRIDGE CT
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-1397
Practice Address - Country:US
Practice Address - Phone:248-444-0443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302415788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist