Provider Demographics
NPI:1013440460
Name:AHMAD, MAQSOOD (RPH)
Entity Type:Individual
Prefix:
First Name:MAQSOOD
Middle Name:
Last Name:AHMAD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12170 CONANT ST STE E
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48212-4129
Mailing Address - Country:US
Mailing Address - Phone:313-366-3800
Mailing Address - Fax:
Practice Address - Street 1:12170 CONANT ST STE E
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-4129
Practice Address - Country:US
Practice Address - Phone:313-366-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist