Provider Demographics
NPI:1578185351
Name:ALNABHAN, BASMA ZUHAIR
Entity Type:Individual
Prefix:
First Name:BASMA
Middle Name:ZUHAIR
Last Name:ALNABHAN
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 1:519 VILLA LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2777
Mailing Address - Country:US
Mailing Address - Phone:586-343-6363
Mailing Address - Fax:
Practice Address - Street 1:29306 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2712
Practice Address - Country:US
Practice Address - Phone:586-200-1824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist