Provider Demographics
NPI:1861182941
Name:AYOUB, MUSTAPHA (PHARMD)
Entity type:Individual
Prefix:
First Name:MUSTAPHA
Middle Name:
Last Name:AYOUB
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 1:515 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1517
Mailing Address - Country:US
Mailing Address - Phone:313-627-0707
Mailing Address - Fax:
Practice Address - Street 1:2616 WASHTENAW RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1505
Practice Address - Country:US
Practice Address - Phone:734-583-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist