Healthcare Provider Details

I. General information

NPI: 1194408369
Provider Name (Legal Business Name): HUSSEIN SEKLAWI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4621 WICHERS DR
MARRERO LA
70072-3020
US

IV. Provider business mailing address

4621 WICHERS DR
MARRERO LA
70072-3020
US

V. Phone/Fax

Practice location:
  • Phone: 313-287-4138
  • Fax:
Mailing address:
  • Phone: 313-287-4138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPST.025332
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: