Provider Demographics
NPI:1700348117
Name:BAKDALEYEH, CARMEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:BAKDALEYEH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6932 COOLEY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48383-3406
Mailing Address - Country:US
Mailing Address - Phone:248-767-2416
Mailing Address - Fax:
Practice Address - Street 1:11493 N LINDEN RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-8586
Practice Address - Country:US
Practice Address - Phone:810-564-4278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist