Provider Demographics
NPI:1770036576
Name:SARSOUR, AHMAD SAMIR (PHARMD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:SAMIR
Last Name:SARSOUR
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 1:5355 BOYD ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-2827
Mailing Address - Country:US
Mailing Address - Phone:989-717-8090
Mailing Address - Fax:
Practice Address - Street 1:5355 BOYD ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2827
Practice Address - Country:US
Practice Address - Phone:989-717-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03132245183500000X, 1835P2201X
MI5302041443183500000X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care