Provider Demographics
NPI:1376718296
Name:SAHOM, HISHAM N (RPH)
Entity Type:Individual
Prefix:MR
First Name:HISHAM
Middle Name:N
Last Name:SAHOM
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 1:522 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-1818
Mailing Address - Country:US
Mailing Address - Phone:616-808-6837
Mailing Address - Fax:616-949-5709
Practice Address - Street 1:5859 28TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6905
Practice Address - Country:US
Practice Address - Phone:616-949-9892
Practice Address - Fax:616-949-5709
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist