Provider Demographics
NPI:1497391718
Name:SAADALLAH, RAFI
Entity Type:Individual
Prefix:
First Name:RAFI
Middle Name:
Last Name:SAADALLAH
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 1:1237 COOLIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-7012
Mailing Address - Country:US
Mailing Address - Phone:248-519-1321
Mailing Address - Fax:
Practice Address - Street 1:1237 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7012
Practice Address - Country:US
Practice Address - Phone:248-519-1321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist