Provider Demographics
NPI:1407487580
Name:NAHLE, BILAL
Entity Type:Individual
Prefix:
First Name:BILAL
Middle Name:
Last Name:NAHLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15740 GARY LN
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-2330
Mailing Address - Country:US
Mailing Address - Phone:313-478-7708
Mailing Address - Fax:
Practice Address - Street 1:900 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1222
Practice Address - Country:US
Practice Address - Phone:248-543-9940
Practice Address - Fax:248-414-5756
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist