Healthcare Provider Details

I. General information

NPI: 1467384172
Provider Name (Legal Business Name): YARA KANNAB AIDA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 AUTO CLUB DR SUIT 200
DEARBORN MI
48126
US

IV. Provider business mailing address

4108 GREENSBORO DR
TROY MI
48085
US

V. Phone/Fax

Practice location:
  • Phone: 313-203-5300
  • Fax:
Mailing address:
  • Phone: 248-567-9342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302418567
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: