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General NPI Number Information
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NPI Number | 1114543550
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Entity Type | Individual
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Provider Name | ISTABRAK HARITH SARSAM RPH
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Gender | Male
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Dates
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Enumeration Date | 06/22/2020
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Last Update Date | 06/22/2020
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Provider Practice Location Address
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Address Line | 26800 JOHN R RD
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-3621
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Country | US
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Telephone | 248-546-2872
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Fax | 248-546-3354
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Provider Business Mailing Address
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Address Line | 26800 JOHN R RD
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-3621
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Country | US
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Telephone | 248-546-2872
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Fax | 248-546-3354
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 76395
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302044686
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License Number State | MI
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