Provider Demographics
NPI:1831417500
Name:RESTUM, GHADA A (RPH)
Entity type:Individual
Prefix:MS
First Name:GHADA
Middle Name:A
Last Name:RESTUM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9155 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-2365
Mailing Address - Country:US
Mailing Address - Phone:313-291-6050
Mailing Address - Fax:313-291-8743
Practice Address - Street 1:9155 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-2365
Practice Address - Country:US
Practice Address - Phone:313-291-6050
Practice Address - Fax:313-291-8743
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028337183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist