Provider Demographics
NPI:1629702113
Name:KAKO, SHAHAD
Entity Type:Individual
Prefix:
First Name:SHAHAD
Middle Name:
Last Name:KAKO
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 1:27535 CORDOBA APT 3101
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3962
Mailing Address - Country:US
Mailing Address - Phone:248-727-3426
Mailing Address - Fax:
Practice Address - Street 1:3669 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-3376
Practice Address - Country:US
Practice Address - Phone:248-647-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2023-08-09
Deactivation Date:2023-07-25
Deactivation Code:
Reactivation Date:2023-08-09
Provider Licenses
StateLicense IDTaxonomies
MI5303020623183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician