Healthcare Provider Details

I. General information

NPI: 1407570914
Provider Name (Legal Business Name): OMAR SAMIR ALHASAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ANN ARBOR RD W
PLYMOUTH MI
48170-2127
US

IV. Provider business mailing address

7616 E MORROW CIR
DEARBORN MI
48126-1240
US

V. Phone/Fax

Practice location:
  • Phone: 734-737-0218
  • Fax:
Mailing address:
  • Phone: 313-505-2979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302414771
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: