Provider Demographics
NPI:1558430744
Name:EID, RENE ABDALLAH (RPH)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:ABDALLAH
Last Name:EID
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 1:3030 ALDERDALE DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-1727
Mailing Address - Country:US
Mailing Address - Phone:586-979-7645
Mailing Address - Fax:313-868-0941
Practice Address - Street 1:2645 W DAVISON
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-3443
Practice Address - Country:US
Practice Address - Phone:313-868-0940
Practice Address - Fax:313-868-0941
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302029449OtherSTATE LICENCE NUMBER