Provider Demographics
NPI:1184131450
Name:MROUEH, ALI
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:MROUEH
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 1:355 54TH ST SW
Mailing Address - Street 2:PHARMACY
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49548
Mailing Address - Country:US
Mailing Address - Phone:616-552-6226
Mailing Address - Fax:616-552-6227
Practice Address - Street 1:154 S MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1692
Practice Address - Country:US
Practice Address - Phone:313-819-3649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist