Provider Demographics
NPI:1013558691
Name:ELMATHIL, ABATESAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:ABATESAM
Middle Name:
Last Name:ELMATHIL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 COMMERCE XING
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3082
Mailing Address - Country:US
Mailing Address - Phone:248-529-2300
Mailing Address - Fax:
Practice Address - Street 1:3000 COMMERCE XING
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-3082
Practice Address - Country:US
Practice Address - Phone:248-529-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist