Provider Demographics
NPI:1518684380
Name:DARSHAM, HASSAN ALI
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:ALI
Last Name:DARSHAM
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 1:7524 ANTHONY ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1386
Mailing Address - Country:US
Mailing Address - Phone:313-213-2660
Mailing Address - Fax:
Practice Address - Street 1:7524 ANTHONY ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1386
Practice Address - Country:US
Practice Address - Phone:313-213-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5351017874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist