Healthcare Provider Details

I. General information

NPI: 1164552162
Provider Name (Legal Business Name): MAIE H ELKASSABY PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 S CEDAR ST
LANSING MI
48910-3028
US

IV. Provider business mailing address

6019 HART ST
EAST LANSING MI
48823-2213
US

V. Phone/Fax

Practice location:
  • Phone: 517-272-9190
  • Fax: 517-272-9464
Mailing address:
  • Phone: 517-351-8406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302029841
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: