Provider Demographics
NPI:1295952778
Name:NASSIF, DALAL MAKRAM (RPH)
Entity type:Individual
Prefix:
First Name:DALAL
Middle Name:MAKRAM
Last Name:NASSIF
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 GOLDEN POND LN
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9555
Mailing Address - Country:US
Mailing Address - Phone:419-824-5365
Mailing Address - Fax:419-318-4392
Practice Address - Street 1:7358 SECOR RD
Practice Address - Street 2:
Practice Address - City:LAMBERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144
Practice Address - Country:US
Practice Address - Phone:734-856-7984
Practice Address - Fax:734-856-7984
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist