Provider Demographics
NPI:1477216497
Name:DGHAILY, SIRAJ (RPH)
Entity Type:Individual
Prefix:DR
First Name:SIRAJ
Middle Name:
Last Name:DGHAILY
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 1:29220 BEECHNUT ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1192
Mailing Address - Country:US
Mailing Address - Phone:786-922-3031
Mailing Address - Fax:
Practice Address - Street 1:6501 N WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-2713
Practice Address - Country:US
Practice Address - Phone:734-729-9210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302413838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist