Provider Demographics
NPI:1407570914
Name:ALHASAN, OMAR SAMIR
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:SAMIR
Last Name:ALHASAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7616 E MORROW CIR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1240
Mailing Address - Country:US
Mailing Address - Phone:313-505-2979
Mailing Address - Fax:
Practice Address - Street 1:800 ANN ARBOR RD W
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2127
Practice Address - Country:US
Practice Address - Phone:734-737-0218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302414771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty