Provider Demographics
NPI:1477671006
Name:PUTRIS, AMIR HASEEB (RPH)
Entity Type:Individual
Prefix:MR
First Name:AMIR
Middle Name:HASEEB
Last Name:PUTRIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 EVERETT DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5071
Mailing Address - Country:US
Mailing Address - Phone:248-853-0032
Mailing Address - Fax:
Practice Address - Street 1:51037 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-4438
Practice Address - Country:US
Practice Address - Phone:586-739-1100
Practice Address - Fax:586-739-5280
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI033823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist