Provider Demographics
NPI:1427541952
Name:NOUR EDDIN, MOHANNAD
Entity Type:Individual
Prefix:
First Name:MOHANNAD
Middle Name:
Last Name:NOUR EDDIN
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 1:42215 PARKSIDE CIR APT 105
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-3349
Mailing Address - Country:US
Mailing Address - Phone:248-346-8793
Mailing Address - Fax:
Practice Address - Street 1:42215 PARKSIDE CIR APT 105
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3349
Practice Address - Country:US
Practice Address - Phone:248-346-8793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-09
Last Update Date:2018-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020245464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist