Provider Demographics
NPI:1932823507
Name:KATOOLA, ROODI GHASSAN-TOBYA
Entity Type:Individual
Prefix:
First Name:ROODI
Middle Name:GHASSAN-TOBYA
Last Name:KATOOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:30704 HUNTSMAN DR E
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1378
Mailing Address - Country:US
Mailing Address - Phone:248-736-1208
Mailing Address - Fax:
Practice Address - Street 1:5990 SASHABAW RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3154
Practice Address - Country:US
Practice Address - Phone:248-736-1208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302414608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty