Provider Demographics
NPI:1457997751
Name:ELKOMOS HANNA, SOHEIR S (RPH)
Entity type:Individual
Prefix:
First Name:SOHEIR
Middle Name:S
Last Name:ELKOMOS HANNA
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 1:1237 COOLIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-7012
Mailing Address - Country:US
Mailing Address - Phone:248-519-1321
Mailing Address - Fax:248-519-1323
Practice Address - Street 1:1237 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7012
Practice Address - Country:US
Practice Address - Phone:248-519-1321
Practice Address - Fax:248-519-1323
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist