Healthcare Provider Details

I. General information

NPI: 1760147524
Provider Name (Legal Business Name): YASIR ALTAMIMI RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2021
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 ANN ARBOR SALINE RD
ANN ARBOR MI
48103-9711
US

IV. Provider business mailing address

6783 WINTHROP ST
DETROIT MI
48228-3767
US

V. Phone/Fax

Practice location:
  • Phone: 734-997-3910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302413956
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: