Provider Demographics
NPI:1295232189
Name:YOUSSEF, SAMER NABIL
Entity Type:Individual
Prefix:
First Name:SAMER
Middle Name:NABIL
Last Name:YOUSSEF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6864 MERRICK DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-1750
Mailing Address - Country:US
Mailing Address - Phone:248-841-5106
Mailing Address - Fax:
Practice Address - Street 1:1380 COOLIDGE HWY STE 125
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7068
Practice Address - Country:US
Practice Address - Phone:248-280-2222
Practice Address - Fax:248-280-2224
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301010604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist