Provider Demographics
NPI:1750866042
Name:CHAMMOUT, HUSSEIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HUSSEIN
Middle Name:
Last Name:CHAMMOUT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26257 SIMONE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3367
Mailing Address - Country:US
Mailing Address - Phone:313-485-7500
Mailing Address - Fax:313-544-7147
Practice Address - Street 1:15617 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3541
Practice Address - Country:US
Practice Address - Phone:313-544-7144
Practice Address - Fax:313-544-7147
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038978183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist