Provider Demographics
NPI:1215230479
Name:KHASHAB, ABDALLAH (PHARMD)
Entity Type:Individual
Prefix:
First Name:ABDALLAH
Middle Name:
Last Name:KHASHAB
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27218 COLLEEN CT
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3635
Mailing Address - Country:US
Mailing Address - Phone:313-848-4182
Mailing Address - Fax:
Practice Address - Street 1:27218 COLLEEN CT
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3635
Practice Address - Country:US
Practice Address - Phone:313-848-4182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036541183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist