Healthcare Provider Details

I. General information

NPI: 1336059211
Provider Name (Legal Business Name): MANDRA QUASSIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20401 HAGGERTY RD
NORTHVILLE MI
48167-1999
US

IV. Provider business mailing address

20401 HAGGERTY RD
NORTHVILLE MI
48167-1999
US

V. Phone/Fax

Practice location:
  • Phone: 248-349-2700
  • Fax:
Mailing address:
  • Phone: 248-349-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302419213
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: