Provider Demographics
NPI:1346867728
Name:ABOUELELLA, SAMAR (PHARD)
Entity Type:Individual
Prefix:
First Name:SAMAR
Middle Name:
Last Name:ABOUELELLA
Suffix:
Gender:F
Credentials:PHARD
Other - Prefix:
Other - First Name:SAMAR
Other - Middle Name:
Other - Last Name:ABOU-EL-ELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:414 LENOX DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1594
Mailing Address - Country:US
Mailing Address - Phone:313-544-0552
Mailing Address - Fax:
Practice Address - Street 1:135 S PROSPECT ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-7914
Practice Address - Country:US
Practice Address - Phone:734-547-4720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031052183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist