Provider Demographics
NPI:1447746094
Name:SALEH, BANDAR (PHARMD)
Entity Type:Individual
Prefix:
First Name:BANDAR
Middle Name:
Last Name:SALEH
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 1:9834 CONANT ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3309
Mailing Address - Country:US
Mailing Address - Phone:313-872-0021
Mailing Address - Fax:313-872-0037
Practice Address - Street 1:9834 CONANT ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3309
Practice Address - Country:US
Practice Address - Phone:313-872-0021
Practice Address - Fax:313-872-0037
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1821354168Medicaid