Provider Demographics
NPI:1871254060
Name:MOUNZER, RABIH
Entity Type:Individual
Prefix:
First Name:RABIH
Middle Name:
Last Name:MOUNZER
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 1:4711 WESTLAND ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2809
Mailing Address - Country:US
Mailing Address - Phone:313-414-7771
Mailing Address - Fax:
Practice Address - Street 1:4711 WESTLAND ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2809
Practice Address - Country:US
Practice Address - Phone:313-414-7771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302413582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist