Provider Demographics
NPI:1639771074
Name:ASSAF, ZAINA
Entity Type:Individual
Prefix:DR
First Name:ZAINA
Middle Name:
Last Name:ASSAF
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 1:3898 FORSTER LN
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-3892
Mailing Address - Country:US
Mailing Address - Phone:407-529-9348
Mailing Address - Fax:
Practice Address - Street 1:2001 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7100
Practice Address - Country:US
Practice Address - Phone:248-435-4556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039826183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist