Provider Demographics
NPI:1205508645
Name:AL RAWAF, MAHMOOD (RPH)
Entity type:Individual
Prefix:
First Name:MAHMOOD
Middle Name:
Last Name:AL RAWAF
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26081 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-1148
Mailing Address - Country:US
Mailing Address - Phone:586-754-7080
Mailing Address - Fax:
Practice Address - Street 1:26081 HOOVER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1148
Practice Address - Country:US
Practice Address - Phone:586-754-7080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2022-11-08
Deactivation Date:2022-04-25
Deactivation Code:
Reactivation Date:2022-11-08
Provider Licenses
StateLicense IDTaxonomies
MI5302413884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist