Provider Demographics
NPI:1851913586
Name:MAKANI, BASMA (PHARMD)
Entity Type:Individual
Prefix:
First Name:BASMA
Middle Name:
Last Name:MAKANI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-2738
Mailing Address - Country:US
Mailing Address - Phone:248-814-6521
Mailing Address - Fax:
Practice Address - Street 1:295 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-2738
Practice Address - Country:US
Practice Address - Phone:248-814-6521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412385183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist