Provider Demographics
NPI:1821257197
Name:YASSA, WESSAM (RPH)
Entity Type:Individual
Prefix:
First Name:WESSAM
Middle Name:
Last Name:YASSA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 W 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017
Mailing Address - Country:US
Mailing Address - Phone:248-435-2410
Mailing Address - Fax:
Practice Address - Street 1:610 E ELMWOOD AVE
Practice Address - Street 2:APT 102
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017
Practice Address - Country:US
Practice Address - Phone:248-435-2410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist