Provider Demographics
NPI:1639849482
Name:RABABEH, ALEXANDER A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:A
Last Name:RABABEH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16459 JOHNSON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8002
Mailing Address - Country:US
Mailing Address - Phone:248-719-5363
Mailing Address - Fax:
Practice Address - Street 1:2300 HAGGERTY RD STE 1070
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2185
Practice Address - Country:US
Practice Address - Phone:248-668-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315216942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1639849482OtherNPPES