Provider Demographics
NPI:1245996404
Name:HAKIM, WAFAA
Entity type:Individual
Prefix:
First Name:WAFAA
Middle Name:
Last Name:HAKIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1242
Mailing Address - Country:US
Mailing Address - Phone:313-960-3330
Mailing Address - Fax:
Practice Address - Street 1:3808 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3620
Practice Address - Country:US
Practice Address - Phone:313-209-3339
Practice Address - Fax:313-586-9522
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist