Healthcare Provider Details

I. General information

NPI: 1194093005
Provider Name (Legal Business Name): SAWSAN BAYDOUN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32732 MICHIGAN AVE
WAYNE MI
48184-1431
US

IV. Provider business mailing address

525 N BEECH DALY RD
DEARBORN HEIGHTS MI
48127-3431
US

V. Phone/Fax

Practice location:
  • Phone: 734-595-9956
  • Fax:
Mailing address:
  • Phone: 313-563-0701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302029939
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: