Provider Demographics
NPI:1881312460
Name:HASIMLLARI, REDJON
Entity type:Individual
Prefix:
First Name:REDJON
Middle Name:
Last Name:HASIMLLARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28903 MAPLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2155
Mailing Address - Country:US
Mailing Address - Phone:734-968-3420
Mailing Address - Fax:
Practice Address - Street 1:8455 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111-1607
Practice Address - Country:US
Practice Address - Phone:734-391-2310
Practice Address - Fax:734-391-2365
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302414516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist