Provider Demographics
NPI:1114349412
Name:HABASHY, SHERIN
Entity Type:Individual
Prefix:
First Name:SHERIN
Middle Name:
Last Name:HABASHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 W CORUNNA AVE
Mailing Address - Street 2:APT 7 B
Mailing Address - City:CORUNNA
Mailing Address - State:MI
Mailing Address - Zip Code:48817-1274
Mailing Address - Country:US
Mailing Address - Phone:773-603-5601
Mailing Address - Fax:
Practice Address - Street 1:1002 E M 21
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9007
Practice Address - Country:US
Practice Address - Phone:989-723-6756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist