Provider Demographics
NPI:1598195802
Name:RAHMAN, RAFI
Entity Type:Individual
Prefix:
First Name:RAFI
Middle Name:
Last Name:RAHMAN
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 1:20270 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-3341
Mailing Address - Country:US
Mailing Address - Phone:313-766-5959
Mailing Address - Fax:313-766-7932
Practice Address - Street 1:20270 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-3341
Practice Address - Country:US
Practice Address - Phone:313-766-5959
Practice Address - Fax:313-766-7932
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301010226183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist