Provider Demographics
NPI:1891326575
Name:NABOULSI, KHIERIEH (RPH)
Entity Type:Individual
Prefix:
First Name:KHIERIEH
Middle Name:
Last Name:NABOULSI
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 1:21911 W 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3742
Mailing Address - Country:US
Mailing Address - Phone:248-353-9898
Mailing Address - Fax:248-353-6400
Practice Address - Street 1:21911 W 11 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3742
Practice Address - Country:US
Practice Address - Phone:248-353-9898
Practice Address - Fax:248-353-6400
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302769496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302029496OtherLICENSE NO.