Provider Demographics
NPI:1437729548
Name:DIAB-EL-HARAKI, MAYSSAA
Entity Type:Individual
Prefix:
First Name:MAYSSAA
Middle Name:
Last Name:DIAB-EL-HARAKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1499
Mailing Address - Country:US
Mailing Address - Phone:313-986-7180
Mailing Address - Fax:
Practice Address - Street 1:394 CHERRY LN
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-1499
Practice Address - Country:US
Practice Address - Phone:313-986-7180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist