Provider Demographics
NPI:1245836030
Name:EISSA, SATTI (RPH)
Entity type:Individual
Prefix:
First Name:SATTI
Middle Name:
Last Name:EISSA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:DR
Other - First Name:SATIE
Other - Middle Name:
Other - Last Name:EISSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-4114
Mailing Address - Country:US
Mailing Address - Phone:248-548-6180
Mailing Address - Fax:
Practice Address - Street 1:209 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-4114
Practice Address - Country:US
Practice Address - Phone:248-548-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist