Provider Demographics
NPI:1245717040
Name:KLEIT, KASSEM (PHARMD)
Entity type:Individual
Prefix:
First Name:KASSEM
Middle Name:
Last Name:KLEIT
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 1:3639 MIDDLEBURY LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3362
Mailing Address - Country:US
Mailing Address - Phone:734-927-2878
Mailing Address - Fax:
Practice Address - Street 1:3270 GREENFIELD RD STE 101
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1161
Practice Address - Country:US
Practice Address - Phone:248-284-6969
Practice Address - Fax:248-284-6963
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302045391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302045391OtherPHARMACIST LICENSE