Provider Demographics
NPI:1164143673
Name:NASSER, SUKEINA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SUKEINA
Middle Name:
Last Name:NASSER
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 1:1329 DACOSTA ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1426
Mailing Address - Country:US
Mailing Address - Phone:313-460-1994
Mailing Address - Fax:
Practice Address - Street 1:919 S MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-1442
Practice Address - Country:US
Practice Address - Phone:734-384-9559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS64120183500000X
MI5302414369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist