Provider Demographics
NPI:1477189082
Name:HABHAB, ALLIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALLIE
Middle Name:
Last Name:HABHAB
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 1:22178 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2702
Mailing Address - Country:US
Mailing Address - Phone:313-456-5565
Mailing Address - Fax:
Practice Address - Street 1:3100 FAIRLANE DR
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2870
Practice Address - Country:US
Practice Address - Phone:313-765-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-14
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020435501835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist