Provider Demographics
NPI:1629795745
Name:ALYASHAE, BASMA (RPH)
Entity Type:Individual
Prefix:
First Name:BASMA
Middle Name:
Last Name:ALYASHAE
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 1:4654 ALPENROSE AVE.
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:ON
Mailing Address - Zip Code:N9G2S5
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2907 KRAFFT RD
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-8628
Practice Address - Country:US
Practice Address - Phone:810-987-6346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53024146511835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist