Provider Demographics
NPI:1760763130
Name:JAHSHAN, ROLA CHRISTINE
Entity Type:Individual
Prefix:
First Name:ROLA
Middle Name:CHRISTINE
Last Name:JAHSHAN
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 1:8850 NEWBURGH RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3425
Mailing Address - Country:US
Mailing Address - Phone:734-524-9663
Mailing Address - Fax:734-524-9670
Practice Address - Street 1:8850 NEWBURGH RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3425
Practice Address - Country:US
Practice Address - Phone:734-524-9663
Practice Address - Fax:734-524-9670
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist