Provider Demographics
NPI:1922629732
Name:HARKOUS, JINAN
Entity Type:Individual
Prefix:
First Name:JINAN
Middle Name:
Last Name:HARKOUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21665 AMBASSADOR DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-1892
Mailing Address - Country:US
Mailing Address - Phone:248-722-0440
Mailing Address - Fax:
Practice Address - Street 1:3255 OWEN RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1755
Practice Address - Country:US
Practice Address - Phone:810-714-2406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist