Provider Demographics
NPI:1891331971
Name:AHMED, AHTASHAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:AHTASHAM
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23191 MARTER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2717
Mailing Address - Country:US
Mailing Address - Phone:586-541-1370
Mailing Address - Fax:
Practice Address - Street 1:23191 MARTER RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2717
Practice Address - Country:US
Practice Address - Phone:586-541-1370
Practice Address - Fax:586-541-1365
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53024116951835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist