Provider Demographics
NPI:1891232302
Name:HAWARI, HOSSAM
Entity Type:Individual
Prefix:
First Name:HOSSAM
Middle Name:
Last Name:HAWARI
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 1:545 W SANILAC RD
Mailing Address - Street 2:PHARMACY
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-9616
Mailing Address - Country:US
Mailing Address - Phone:810-648-5136
Mailing Address - Fax:
Practice Address - Street 1:545 W SANILAC RD
Practice Address - Street 2:PHARMACY
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-9616
Practice Address - Country:US
Practice Address - Phone:810-648-5136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-22
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302043119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist