Provider Demographics
NPI:1477998805
Name:ATRISSI, AMIRA K (RPH)
Entity Type:Individual
Prefix:
First Name:AMIRA
Middle Name:K
Last Name:ATRISSI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23874 KEAN ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1804
Mailing Address - Country:US
Mailing Address - Phone:313-498-7464
Mailing Address - Fax:734-722-4355
Practice Address - Street 1:23874 KEAN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1804
Practice Address - Country:US
Practice Address - Phone:313-498-7464
Practice Address - Fax:734-722-4355
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist