Provider Demographics
NPI:1598841363
Name:ZIADEH, KHAMIS A (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:KHAMIS
Middle Name:A
Last Name:ZIADEH
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22693 WALSINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3867
Mailing Address - Country:US
Mailing Address - Phone:248-478-5635
Mailing Address - Fax:
Practice Address - Street 1:200 S MERRIMAN RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5009
Practice Address - Country:US
Practice Address - Phone:734-721-0372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI19378183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist