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General NPI Number Information
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NPI Number | 1811462849
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Entity Type | Individual
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Provider Name | NASSAR BEYDOUN
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Gender | Male
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Dates
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Enumeration Date | 10/05/2018
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Last Update Date | 10/05/2018
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Provider Practice Location Address
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Address Line | 20225 E 9 MILE RD STE 120A
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1700
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Country | US
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Telephone | 313-999-8560
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Fax |
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Provider Business Mailing Address
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Address Line | 6020 CAMPUS DR
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-2550
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Country | US
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Telephone |
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Fax |
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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 | 5302043292
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License Number State | MI
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