Provider Demographics
NPI:1336436781
Name:WASFY, HALA (RPH)
Entity Type:Individual
Prefix:
First Name:HALA
Middle Name:
Last Name:WASFY
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 1:23792 STACEY DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-5450
Mailing Address - Country:US
Mailing Address - Phone:734-783-1446
Mailing Address - Fax:
Practice Address - Street 1:3100 FAIRLANE DR
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2870
Practice Address - Country:US
Practice Address - Phone:313-768-0065
Practice Address - Fax:734-768-0065
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist