Provider Demographics
NPI:1790371755
Name:AL-NABOLSI, MOHANNAD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MOHANNAD
Middle Name:
Last Name:AL-NABOLSI
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 1:6900 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1763
Mailing Address - Country:US
Mailing Address - Phone:313-663-6165
Mailing Address - Fax:
Practice Address - Street 1:20434 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1416
Practice Address - Country:US
Practice Address - Phone:248-478-3922
Practice Address - Fax:248-478-3923
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302044205183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist