Provider Demographics
NPI:1457993099
Name:SLAIBE, WASSEM MOHAMAD (RPH)
Entity Type:Individual
Prefix:DR
First Name:WASSEM
Middle Name:MOHAMAD
Last Name:SLAIBE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 N JOHN DALY RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-4103
Mailing Address - Country:US
Mailing Address - Phone:313-212-6000
Mailing Address - Fax:
Practice Address - Street 1:1700 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-4005
Practice Address - Country:US
Practice Address - Phone:517-817-0326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist