Provider Demographics
NPI:1356441026
Name:ANKOUNI, AHMED HASSAN (RPH)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:HASSAN
Last Name:ANKOUNI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-1745
Mailing Address - Country:US
Mailing Address - Phone:313-237-9000
Mailing Address - Fax:313-237-9961
Practice Address - Street 1:1411 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-1745
Practice Address - Country:US
Practice Address - Phone:313-237-9000
Practice Address - Fax:313-237-9961
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2015-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist