Provider Demographics
NPI:1952058661
Name:HARB, AHMAD ALI
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:ALI
Last Name:HARB
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 1:25428 ELON DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3805
Mailing Address - Country:US
Mailing Address - Phone:313-549-5009
Mailing Address - Fax:
Practice Address - Street 1:100 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4325
Practice Address - Country:US
Practice Address - Phone:517-318-0304
Practice Address - Fax:517-318-0305
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302414048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist