Healthcare Provider Details

I. General information

NPI: 1760391510
Provider Name (Legal Business Name): SANAM SHARMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2119
US

IV. Provider business mailing address

2252 RANDOLPH AVE
WINDSOR ONTARIO
N9B3V8
CA

V. Phone/Fax

Practice location:
  • Phone: 313-745-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302418057
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: