Provider Demographics
NPI:1144825571
Name:ALGAZZALY, MUBARAK (PHARMD)
Entity type:Individual
Prefix:
First Name:MUBARAK
Middle Name:
Last Name:ALGAZZALY
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 1:5408 WHITTAKER RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9751
Mailing Address - Country:US
Mailing Address - Phone:734-481-3381
Mailing Address - Fax:
Practice Address - Street 1:42433 FORD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3303
Practice Address - Country:US
Practice Address - Phone:734-981-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302413119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist