Provider Demographics
NPI:1548986979
Name:AL-MAWLA, ALI
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:AL-MAWLA
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 1:25864 CHERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3743
Mailing Address - Country:US
Mailing Address - Phone:313-952-0050
Mailing Address - Fax:
Practice Address - Street 1:10652 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-1200
Practice Address - Country:US
Practice Address - Phone:313-571-0041
Practice Address - Fax:313-571-0449
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist