Healthcare Provider Details

I. General information

NPI: 1295952778
Provider Name (Legal Business Name): DALAL MAKRAM NASSIF RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7358 SECOR RD
LAMBERVILLE MI
48144
US

IV. Provider business mailing address

5608 GOLDEN POND LN
SYLVANIA OH
43560-9555
US

V. Phone/Fax

Practice location:
  • Phone: 734-856-7984
  • Fax: 734-856-7984
Mailing address:
  • Phone: 419-824-5365
  • Fax: 419-318-4392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302034107
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: