Provider Demographics
NPI:1023778552
Name:MOHAMMAD, AMNA IMAD (RPH)
Entity type:Individual
Prefix:MRS
First Name:AMNA
Middle Name:IMAD
Last Name:MOHAMMAD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 MYSTIC FOREST CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2735
Mailing Address - Country:US
Mailing Address - Phone:248-719-2314
Mailing Address - Fax:
Practice Address - Street 1:13031 CONANT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-2361
Practice Address - Country:US
Practice Address - Phone:313-893-3339
Practice Address - Fax:313-893-3337
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-24
Last Update Date:2021-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412375183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist