Provider Demographics
NPI:1811598931
Name:ESSI, FADY
Entity Type:Individual
Prefix:
First Name:FADY
Middle Name:
Last Name:ESSI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35252 EDEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-3831
Mailing Address - Country:US
Mailing Address - Phone:586-306-2736
Mailing Address - Fax:
Practice Address - Street 1:6160 S SAGINAW ROAD
Practice Address - Street 2:GRAND BLANC
Practice Address - City:48439
Practice Address - State:USA
Practice Address - Zip Code:48439
Practice Address - Country:UM
Practice Address - Phone:819-603-9702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist