Provider Demographics
NPI:1336707975
Name:HASAN, ASRA MOHAMMED HABIBUL (PHAMD)
Entity Type:Individual
Prefix:DR
First Name:ASRA
Middle Name:MOHAMMED HABIBUL
Last Name:HASAN
Suffix:
Gender:F
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 CREEKSIDE CIR APT 203
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-4521
Mailing Address - Country:US
Mailing Address - Phone:847-852-6923
Mailing Address - Fax:
Practice Address - Street 1:2506 E HILL RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-5066
Practice Address - Country:US
Practice Address - Phone:810-606-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315187274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist