Provider Demographics
NPI:1568185882
Name:BEYDOUN, RACHA
Entity Type:Individual
Prefix:
First Name:RACHA
Middle Name:
Last Name:BEYDOUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 FORT ST
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-3841
Mailing Address - Country:US
Mailing Address - Phone:734-283-9640
Mailing Address - Fax:
Practice Address - Street 1:2025 FORT ST
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-3841
Practice Address - Country:US
Practice Address - Phone:734-283-9640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302414172183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist