Provider Demographics
NPI:1952966525
Name:KRAIDI, HASSAN MOHAMAD
Entity Type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:MOHAMAD
Last Name:KRAIDI
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 1:122 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-1068
Mailing Address - Country:US
Mailing Address - Phone:517-663-6811
Mailing Address - Fax:
Practice Address - Street 1:122 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EATON RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:48827-1068
Practice Address - Country:US
Practice Address - Phone:517-663-6811
Practice Address - Fax:517-663-1732
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020429791835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist