Provider Demographics
NPI:1831799295
Name:MIAH, MIZANUR RAHMAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MIZANUR
Middle Name:RAHMAN
Last Name:MIAH
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 1:14509 ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-4369
Mailing Address - Country:US
Mailing Address - Phone:313-485-2128
Mailing Address - Fax:
Practice Address - Street 1:29176 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-6764
Practice Address - Country:US
Practice Address - Phone:586-467-0265
Practice Address - Fax:586-467-0259
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302044571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist