Provider Demographics
NPI:1881062883
Name:YOUSEF, WESSAM (RPH, MBA)
Entity type:Individual
Prefix:
First Name:WESSAM
Middle Name:
Last Name:YOUSEF
Suffix:
Gender:M
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6864 MERRICK DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-1750
Mailing Address - Country:US
Mailing Address - Phone:248-339-6790
Mailing Address - Fax:
Practice Address - Street 1:1821 N CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-4237
Practice Address - Country:US
Practice Address - Phone:248-237-4455
Practice Address - Fax:248-237-4453
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020344981835G0303X, 1835N1003X, 1835P0018X, 1835X0200X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835X0200XPharmacy Service ProvidersPharmacistOncology