Provider Demographics
NPI:1265932503
Name:TOOR, ZEESHAN H
Entity type:Individual
Prefix:
First Name:ZEESHAN
Middle Name:H
Last Name:TOOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16970 E 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-7719
Mailing Address - Country:US
Mailing Address - Phone:586-879-0997
Mailing Address - Fax:586-879-0967
Practice Address - Street 1:16970 E 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-7719
Practice Address - Country:US
Practice Address - Phone:586-879-0997
Practice Address - Fax:586-879-0967
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302045113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302045113Medicaid