Provider Demographics
NPI:1417429747
Name:ATOUI, HASSAN MAHMOUD (RPH)
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:MAHMOUD
Last Name:ATOUI
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 1:484 BERWYN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3737
Mailing Address - Country:US
Mailing Address - Phone:313-377-4000
Mailing Address - Fax:313-564-1777
Practice Address - Street 1:18250 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3427
Practice Address - Country:US
Practice Address - Phone:313-818-1810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist