Provider Demographics
NPI:1710062922
Name:YAZBECK, GHASSAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:GHASSAN
Middle Name:
Last Name:YAZBECK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2676 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-1237
Mailing Address - Country:US
Mailing Address - Phone:313-871-3285
Mailing Address - Fax:313-871-0788
Practice Address - Street 1:2676 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-1237
Practice Address - Country:US
Practice Address - Phone:313-871-3285
Practice Address - Fax:313-871-0788
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist