Provider Demographics
NPI:1407622616
Name:SHLLAKU, NIKOL (PHARMD)
Entity Type:Individual
Prefix:
First Name:NIKOL
Middle Name:
Last Name:SHLLAKU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13020 S US HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-9325
Mailing Address - Country:US
Mailing Address - Phone:517-624-5028
Mailing Address - Fax:
Practice Address - Street 1:13020 S US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-9325
Practice Address - Country:US
Practice Address - Phone:517-624-5028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302415722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist