Provider Demographics
NPI:1972812352
Name:KHREIZAT, HASSAN SAMI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:SAMI
Last Name:KHREIZAT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 E 14 MILE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-4369
Mailing Address - Country:US
Mailing Address - Phone:586-274-9030
Mailing Address - Fax:586-274-4881
Practice Address - Street 1:4600 E 14 MILE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4369
Practice Address - Country:US
Practice Address - Phone:586-274-9030
Practice Address - Fax:586-274-4881
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist