Provider Demographics
NPI:1376027524
Name:ABDULGHANI, SARA GHAZI
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:GHAZI
Last Name:ABDULGHANI
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 1:5696 BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2402
Mailing Address - Country:US
Mailing Address - Phone:313-523-1399
Mailing Address - Fax:
Practice Address - Street 1:31415 FORD RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-1821
Practice Address - Country:US
Practice Address - Phone:732-367-0692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-23
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302046273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist