Provider Demographics
NPI:1750473815
Name:DARWICH, ALI M (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALI
Middle Name:M
Last Name:DARWICH
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 1:12169 JOS CAMPAU ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-2693
Mailing Address - Country:US
Mailing Address - Phone:313-365-2400
Mailing Address - Fax:313-365-2401
Practice Address - Street 1:12169 JOS CAMPAU ST STE 101
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-2693
Practice Address - Country:US
Practice Address - Phone:313-365-2400
Practice Address - Fax:313-365-2401
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5301007734OtherSTATE LICENSE