Provider Demographics
NPI:1417510462
Name:BEYDOUN, MOHAMED A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:A
Last Name:BEYDOUN
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 1:551 LINN ST STE 120
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-1591
Mailing Address - Country:US
Mailing Address - Phone:269-673-4700
Mailing Address - Fax:
Practice Address - Street 1:551 LINN ST STE 120
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1591
Practice Address - Country:US
Practice Address - Phone:269-673-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020471861835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1871641878Medicaid