Healthcare Provider Details

I. General information

NPI: 1891232302
Provider Name (Legal Business Name): HOSSAM HAWARI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2017
Last Update Date: 01/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 W SANILAC RD PHARMACY
SANDUSKY MI
48471-9616
US

IV. Provider business mailing address

545 W SANILAC RD PHARMACY
SANDUSKY MI
48471-9616
US

V. Phone/Fax

Practice location:
  • Phone: 810-648-5136
  • Fax:
Mailing address:
  • Phone: 810-648-5136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302043119
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: