Provider Demographics
NPI:1760810097
Name:KENAYA, REEM
Entity Type:Individual
Prefix:
First Name:REEM
Middle Name:
Last Name:KENAYA
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 1:2000 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-1380
Mailing Address - Country:US
Mailing Address - Phone:586-756-7680
Mailing Address - Fax:586-756-5829
Practice Address - Street 1:2000 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-1380
Practice Address - Country:US
Practice Address - Phone:586-756-7680
Practice Address - Fax:586-756-5829
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302032072OtherSTATE OF MICHIGAN LICENSE