Provider Demographics
NPI:1073144846
Name:KASSAB SITTO, SAHAR
Entity Type:Individual
Prefix:
First Name:SAHAR
Middle Name:
Last Name:KASSAB SITTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-1701
Mailing Address - Country:US
Mailing Address - Phone:248-541-1650
Mailing Address - Fax:248-414-5753
Practice Address - Street 1:33 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030-1701
Practice Address - Country:US
Practice Address - Phone:248-541-1650
Practice Address - Fax:248-414-5753
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist