Provider Demographics
NPI:1205326352
Name:SABBAGH, HUSSEIN MAHMOUD (RPH)
Entity type:Individual
Prefix:
First Name:HUSSEIN
Middle Name:MAHMOUD
Last Name:SABBAGH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5271 TERNES ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4625
Mailing Address - Country:US
Mailing Address - Phone:313-516-5006
Mailing Address - Fax:
Practice Address - Street 1:4515 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125-1934
Practice Address - Country:US
Practice Address - Phone:313-438-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist