Provider Demographics
NPI:1457120024
Name:ELZAGHIR, MAHMOUD MOHAMAD (PHARMD)
Entity type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:MOHAMAD
Last Name:ELZAGHIR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10550 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER ROUGE
Mailing Address - State:MI
Mailing Address - Zip Code:48218-1307
Mailing Address - Country:US
Mailing Address - Phone:313-438-6825
Mailing Address - Fax:
Practice Address - Street 1:10550 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:RIVER ROUGE
Practice Address - State:MI
Practice Address - Zip Code:48218-1307
Practice Address - Country:US
Practice Address - Phone:313-438-6825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-25
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302415607183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist