Provider Demographics
NPI:1164552162
Name:ELKASSABY, MAIE H (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MAIE
Middle Name:H
Last Name:ELKASSABY
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6019 HART ST
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-2213
Mailing Address - Country:US
Mailing Address - Phone:517-351-8406
Mailing Address - Fax:
Practice Address - Street 1:2701 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3028
Practice Address - Country:US
Practice Address - Phone:517-272-9190
Practice Address - Fax:517-272-9464
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist