Provider Demographics
NPI:1205104833
Name:RESTUM, ALY ASAD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALY
Middle Name:ASAD
Last Name:RESTUM
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 1:218 N ROSEVERE AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1736
Mailing Address - Country:US
Mailing Address - Phone:313-600-5588
Mailing Address - Fax:
Practice Address - Street 1:38035 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1065
Practice Address - Country:US
Practice Address - Phone:866-222-3808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-10
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist