Provider Demographics
NPI:1639436967
Name:BARAKAT, JAAFAR AHMAD (RPH)
Entity type:Individual
Prefix:MR
First Name:JAAFAR
Middle Name:AHMAD
Last Name:BARAKAT
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 1:18250 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-3427
Mailing Address - Country:US
Mailing Address - Phone:313-240-9700
Mailing Address - Fax:313-240-9705
Practice Address - Street 1:4971 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4619
Practice Address - Country:US
Practice Address - Phone:313-240-9700
Practice Address - Fax:313-204-9705
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302028718OtherPHARMACIST LISCENCE