Healthcare Provider Details

I. General information

NPI: 1427511559
Provider Name (Legal Business Name): SAADQA IRUM SUMBAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2019
Last Update Date: 04/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 W SAGINAW ST
LANSING MI
48915-1966
US

IV. Provider business mailing address

1019 W SAGINAW ST
LANSING MI
48915-1966
US

V. Phone/Fax

Practice location:
  • Phone: 517-374-6103
  • Fax: 517-374-0986
Mailing address:
  • Phone: 517-374-6103
  • Fax: 517-374-0986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302040143
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5315106646
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: