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General NPI Number Information
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NPI Number | 1558466953
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Entity Type | Individual
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Provider Name | HASSANE I SHUAYTO PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15000 GRATIOT AVE SUITE 140
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City | DETROIT
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State | MI
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Zip | 48205-1973
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Country | US
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Telephone | 313-521-7000
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Fax | 313-245-1942
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Provider Business Mailing Address
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Address Line | 15000 GRATIOT AVE SUITE 140
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City | DETROIT
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State | MI
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Zip | 48205-1973
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Country | US
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Telephone | 313-521-7000
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Fax | 313-245-1942
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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 | 5301006382
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License Number State | MI
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