Provider Demographics
NPI:1497277115
Name:ASADI, GASSAN
Entity Type:Individual
Prefix:
First Name:GASSAN
Middle Name:
Last Name:ASADI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2544 BEACHVIEW CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-4203
Mailing Address - Country:US
Mailing Address - Phone:269-352-6385
Mailing Address - Fax:248-817-2455
Practice Address - Street 1:215 E BIG BEAVER RD STE 500
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083
Practice Address - Country:US
Practice Address - Phone:248-817-6770
Practice Address - Fax:248-817-2455
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-14
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist