Provider Demographics
NPI:1619179660
Name:HADDAD, DIANA GHANEM (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:GHANEM
Last Name:HADDAD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5812 BAYPOINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3110
Mailing Address - Country:US
Mailing Address - Phone:248-620-3453
Mailing Address - Fax:
Practice Address - Street 1:2971 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7032
Practice Address - Country:US
Practice Address - Phone:248-288-4385
Practice Address - Fax:248-288-2173
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032627183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist