Provider Demographics
NPI:1790308831
Name:KHOCHEICHE, ALI JIHAD (PHARMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:JIHAD
Last Name:KHOCHEICHE
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24739 EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1537
Mailing Address - Country:US
Mailing Address - Phone:313-523-1633
Mailing Address - Fax:
Practice Address - Street 1:1444 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48216-1324
Practice Address - Country:US
Practice Address - Phone:313-523-1633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-23
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302043664183500000X
MI53010128963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes183500000XPharmacy Service ProvidersPharmacist