Provider Demographics
NPI:1346483179
Name:ESSAK, MARK MINA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:MINA
Last Name:ESSAK
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 1:1833 FREEMONT DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2564
Mailing Address - Country:US
Mailing Address - Phone:248-515-5230
Mailing Address - Fax:248-952-1828
Practice Address - Street 1:1833 FREEMONT DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-2564
Practice Address - Country:US
Practice Address - Phone:248-515-5230
Practice Address - Fax:248-952-1828
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist