Provider Demographics
NPI:1669594099
Name:ABDALLAH, HASSAN SUBHI (RPH)
Entity type:Individual
Prefix:MR
First Name:HASSAN
Middle Name:SUBHI
Last Name:ABDALLAH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:HASSAN
Other - Middle Name:SUBHI
Other - Last Name:ABDALLAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:2625 MICHAEL DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3582
Mailing Address - Country:US
Mailing Address - Phone:586-914-0116
Mailing Address - Fax:313-579-2067
Practice Address - Street 1:11937 E WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-1665
Practice Address - Country:US
Practice Address - Phone:313-579-1755
Practice Address - Fax:313-579-2067
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist