Provider Demographics
NPI:1134770076
Name:SANEH, MOHAMED ALI
Entity type:Individual
Prefix:
First Name:MOHAMED ALI
Middle Name:
Last Name:SANEH
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 1:427 SANDALWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-3028
Mailing Address - Country:US
Mailing Address - Phone:734-846-8569
Mailing Address - Fax:
Practice Address - Street 1:4515 CORUNNA RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4317
Practice Address - Country:US
Practice Address - Phone:810-732-7011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist