Healthcare Provider Details

I. General information

NPI: 1679810055
Provider Name (Legal Business Name): MICHELLE KHITAM MOHAMMED SALTI JABER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2013
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 TRUSE PKWY
MEMPHIS TN
38117-5354
US

IV. Provider business mailing address

799 TRUSE PKWY
MEMPHIS TN
38117-5354
US

V. Phone/Fax

Practice location:
  • Phone: 901-683-2974
  • Fax:
Mailing address:
  • Phone: 901-683-2974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number29710
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: