Healthcare Provider Details

I. General information

NPI: 1467738922
Provider Name (Legal Business Name): LAYTH ESKANDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34899 GROESBECK HWY
CLINTON TWP MI
48035
US

IV. Provider business mailing address

34899 GROESBECK HWY
CLINTON TWP MI
48035-3366
US

V. Phone/Fax

Practice location:
  • Phone: 586-741-0105
  • Fax: 586-741-0109
Mailing address:
  • Phone: 586-741-0105
  • Fax: 586-741-0109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302033181
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: