Provider Demographics
NPI:1770717845
Name:HAGERAHMA, AFAFF MOHAMED AHMED
Entity type:Individual
Prefix:
First Name:AFAFF
Middle Name:MOHAMED AHMED
Last Name:HAGERAHMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4407 LIVERNOIS AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48210-2437
Mailing Address - Country:US
Mailing Address - Phone:313-310-7497
Mailing Address - Fax:
Practice Address - Street 1:4407 LIVERNOIS AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-2437
Practice Address - Country:US
Practice Address - Phone:313-310-7494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037991183500000X
MI5301012915333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes183500000XPharmacy Service ProvidersPharmacist