Provider Demographics
NPI:1861019861
Name:AOUDE, IMAN IMAD
Entity Type:Individual
Prefix:
First Name:IMAN
Middle Name:IMAD
Last Name:AOUDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23007 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:MI
Mailing Address - Zip Code:48134-9028
Mailing Address - Country:US
Mailing Address - Phone:734-675-6663
Mailing Address - Fax:734-675-8077
Practice Address - Street 1:23007 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:MI
Practice Address - Zip Code:48134-9028
Practice Address - Country:US
Practice Address - Phone:734-675-6663
Practice Address - Fax:734-675-8077
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302043353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist