Provider Demographics
NPI:1417608639
Name:ASSOUAD, ROLA (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:ROLA
Middle Name:
Last Name:ASSOUAD
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8623 N TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1489
Mailing Address - Country:US
Mailing Address - Phone:313-277-4546
Mailing Address - Fax:
Practice Address - Street 1:8623 N TELEGRAPH RD STE 2
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1489
Practice Address - Country:US
Practice Address - Phone:313-277-4546
Practice Address - Fax:313-277-4547
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035186183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist