Provider Demographics
NPI:1750036752
Name:ELGHONIMY, ANAS (RPH)
Entity Type:Individual
Prefix:
First Name:ANAS
Middle Name:
Last Name:ELGHONIMY
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 1:2818 LONG MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5931
Mailing Address - Country:US
Mailing Address - Phone:313-559-7906
Mailing Address - Fax:
Practice Address - Street 1:209 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-4114
Practice Address - Country:US
Practice Address - Phone:248-548-6180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302044281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist