Provider Demographics
NPI:1033892211
Name:ABBAS, MALAK M (PHARMD)
Entity Type:Individual
Prefix:
First Name:MALAK
Middle Name:M
Last Name:ABBAS
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 1:7725 WISCONSIN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1286
Mailing Address - Country:US
Mailing Address - Phone:313-574-1922
Mailing Address - Fax:
Practice Address - Street 1:7725 WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1286
Practice Address - Country:US
Practice Address - Phone:313-574-1922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042103183500000X, 1835E0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacist
No1835E0208XPharmacy Service ProvidersPharmacistEmergency MedicineGroup - Single Specialty