Provider Demographics
NPI:1376054221
Name:DABAJA, SHAFICA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SHAFICA
Middle Name:
Last Name:DABAJA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5816 OAKMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2326
Mailing Address - Country:US
Mailing Address - Phone:313-443-1516
Mailing Address - Fax:
Practice Address - Street 1:6450 MAPLE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2259
Practice Address - Country:US
Practice Address - Phone:313-216-2213
Practice Address - Fax:313-584-3249
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist