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General NPI Number Information
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NPI Number | 1912798620
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Entity Type | Individual
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Provider Name | LIAL JAWDAT ALTAIE
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Gender | Female
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 7488 VILLAGE CENTER DR
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City | WHITMORE LAKE
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State | MI
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Zip | 48189-7100
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Country | US
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Telephone | 810-231-4179
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Fax |
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Provider Business Mailing Address
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Address Line | 3830 S SHORELINE DR
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City | MILFORD
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State | MI
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Zip | 48381-4806
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Country | US
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Telephone | 248-931-2032
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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 | 5302416966
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License Number State | MI
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