Provider Demographics
NPI:1316376932
Name:ATISHA, MAREEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MAREEN
Middle Name:
Last Name:ATISHA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 BLOOMFIELD WOODS CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-1914
Mailing Address - Country:US
Mailing Address - Phone:248-821-4355
Mailing Address - Fax:
Practice Address - Street 1:400 BROWN RD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-1305
Practice Address - Country:US
Practice Address - Phone:248-648-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist