Provider Demographics
NPI:1235677386
Name:FADLALLAH, HASSANE (RPH)
Entity Type:Individual
Prefix:
First Name:HASSANE
Middle Name:
Last Name:FADLALLAH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10066 DIX
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1551
Mailing Address - Country:US
Mailing Address - Phone:313-843-2400
Mailing Address - Fax:313-843-2402
Practice Address - Street 1:10066 DIX
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1551
Practice Address - Country:US
Practice Address - Phone:313-843-2400
Practice Address - Fax:313-843-2402
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist