Provider Demographics
NPI:1437812526
Name:HANAKACHAL, MARIAM G (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:G
Last Name:HANAKACHAL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38545 LOWELL DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1177
Mailing Address - Country:US
Mailing Address - Phone:248-225-1036
Mailing Address - Fax:
Practice Address - Street 1:7498 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-1067
Practice Address - Country:US
Practice Address - Phone:248-592-2063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302413905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist