Healthcare Provider Details

I. General information

NPI: 1700593720
Provider Name (Legal Business Name): HAWRAA RAAD ALHASSAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 FORT ST
WYANDOTTE MI
48192-3841
US

IV. Provider business mailing address

2025 FORT ST
WYANDOTTE MI
48192-3841
US

V. Phone/Fax

Practice location:
  • Phone: 734-283-9640
  • Fax:
Mailing address:
  • Phone: 734-283-9640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302414827
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: