Provider Demographics
NPI:1548868094
Name:AL-GHURBANI, EHAB S
Entity type:Individual
Prefix:
First Name:EHAB
Middle Name:S
Last Name:AL-GHURBANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 WOOD POINTE LN # 2
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-3380
Mailing Address - Country:US
Mailing Address - Phone:734-353-8201
Mailing Address - Fax:
Practice Address - Street 1:945 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2400
Practice Address - Country:US
Practice Address - Phone:989-686-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI202530609331835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist