Provider Demographics
NPI:1700486925
Name:ALY, AHMED M (RPH)
Entity type:Individual
Prefix:MR
First Name:AHMED
Middle Name:M
Last Name:ALY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:159 CROCKER BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2546
Mailing Address - Country:US
Mailing Address - Phone:586-223-6946
Mailing Address - Fax:989-673-7916
Practice Address - Street 1:1121 E CARO RD
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1216
Practice Address - Country:US
Practice Address - Phone:989-673-7922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist