Healthcare Provider Details

I. General information

NPI: 1942876636
Provider Name (Legal Business Name): ZAHRA SHABIR KANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
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 TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303033342
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: