Provider Demographics
NPI:1518470178
Name:DABAJA, ALI AHMAD (PHARMACIST)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:AHMAD
Last Name:DABAJA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6429 YINGER AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2029
Mailing Address - Country:US
Mailing Address - Phone:313-629-6860
Mailing Address - Fax:
Practice Address - Street 1:5650 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2253
Practice Address - Country:US
Practice Address - Phone:313-581-3280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist