Provider Demographics
NPI:1295861110
Name:CHAYTOU, ALLI H (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALLI
Middle Name:H
Last Name:CHAYTOU
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 1:20252 BROOKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2766
Mailing Address - Country:US
Mailing Address - Phone:313-336-5677
Mailing Address - Fax:313-336-0243
Practice Address - Street 1:20252 BROOKWOOD ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2766
Practice Address - Country:US
Practice Address - Phone:313-336-5677
Practice Address - Fax:313-336-0243
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist