Provider Demographics
NPI:1396414652
Name:KASSAB, SAMAR BUNI
Entity Type:Individual
Prefix:
First Name:SAMAR
Middle Name:BUNI
Last Name:KASSAB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMAR
Other - Middle Name:FARIS FAREED
Other - Last Name:BUNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23201 MARTER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2729
Mailing Address - Country:US
Mailing Address - Phone:586-773-1100
Mailing Address - Fax:
Practice Address - Street 1:23201 MARTER RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2729
Practice Address - Country:US
Practice Address - Phone:586-773-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183700000X
MI5303011943183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician