Provider Demographics
NPI:1982192738
Name:HAMMOUD, HASSAN AHMAD
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:AHMAD
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 1:6961 PAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1796
Mailing Address - Country:US
Mailing Address - Phone:313-338-4241
Mailing Address - Fax:
Practice Address - Street 1:1684 FORT ST
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-1909
Practice Address - Country:US
Practice Address - Phone:313-383-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302045447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist