Provider Demographics
NPI:1811265028
Name:SANAULLAH, TAHIRA
Entity type:Individual
Prefix:
First Name:TAHIRA
Middle Name:
Last Name:SANAULLAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17755 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINT
Mailing Address - State:MI
Mailing Address - Zip Code:48021
Mailing Address - Country:US
Mailing Address - Phone:248-952-1425
Mailing Address - Fax:248-952-1425
Practice Address - Street 1:17755 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3131
Practice Address - Country:US
Practice Address - Phone:586-778-7582
Practice Address - Fax:586-778-7663
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist