Provider Demographics
NPI:1073284386
Name:AWADA, MAHER KASSEM (RPH)
Entity Type:Individual
Prefix:
First Name:MAHER
Middle Name:KASSEM
Last Name:AWADA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 CHERRY VALLEY DR APT P20
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1416
Mailing Address - Country:US
Mailing Address - Phone:313-969-3963
Mailing Address - Fax:
Practice Address - Street 1:25141 HOOVER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1145
Practice Address - Country:US
Practice Address - Phone:586-459-0836
Practice Address - Fax:586-571-0650
Is Sole Proprietor?:No
Enumeration Date:2021-09-26
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315227531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist