Provider Demographics
NPI:1275260655
Name:KHATIB, HASSAN OMAR (PHARMD)
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:OMAR
Last Name:KHATIB
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 1:18287 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:MELVINDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48122-1513
Mailing Address - Country:US
Mailing Address - Phone:313-386-0830
Mailing Address - Fax:
Practice Address - Street 1:18287 ALLEN RD
Practice Address - Street 2:
Practice Address - City:MELVINDALE
Practice Address - State:MI
Practice Address - Zip Code:48122-1513
Practice Address - Country:US
Practice Address - Phone:313-386-0830
Practice Address - Fax:313-386-0907
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302414481183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist