Provider Demographics
NPI:1649823147
Name:SARSAM, NAMEER
Entity type:Individual
Prefix:
First Name:NAMEER
Middle Name:
Last Name:SARSAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6157 ORCHARD LAKE RD APT 202
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2316
Mailing Address - Country:US
Mailing Address - Phone:619-892-9992
Mailing Address - Fax:
Practice Address - Street 1:800 ANN ARBOR RD W
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2127
Practice Address - Country:US
Practice Address - Phone:734-737-0218
Practice Address - Fax:734-737-0506
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302048440183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist