Provider Demographics
NPI:1144787003
Name:IWAS, HASNA BEHNAM
Entity Type:Individual
Prefix:DR
First Name:HASNA
Middle Name:BEHNAM
Last Name:IWAS
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 1:15200 E JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1304
Mailing Address - Country:US
Mailing Address - Phone:586-295-7221
Mailing Address - Fax:313-822-8780
Practice Address - Street 1:15200 E JEFFERSON AVE STE 102
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-2055
Practice Address - Country:US
Practice Address - Phone:586-295-7221
Practice Address - Fax:313-822-8780
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist