Provider Demographics
NPI:1790069649
Name:JAZRAWI, JEHAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JEHAN
Middle Name:
Last Name:JAZRAWI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 MESA DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-6510
Mailing Address - Country:US
Mailing Address - Phone:248-910-7073
Mailing Address - Fax:
Practice Address - Street 1:3930 MESA DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-6510
Practice Address - Country:US
Practice Address - Phone:248-910-7073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist