Provider Demographics
NPI:1811413073
Name:HAMMOUD, ALI J
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:J
Last Name:HAMMOUD
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 1:1327 MAY ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2711
Mailing Address - Country:US
Mailing Address - Phone:313-693-8020
Mailing Address - Fax:
Practice Address - Street 1:39575 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2949
Practice Address - Country:US
Practice Address - Phone:313-693-8020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-19
Last Update Date:2019-07-31
Deactivation Date:2017-12-13
Deactivation Code:
Reactivation Date:2019-07-31
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy