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General NPI Number Information
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NPI Number | 1932823507
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Entity Type | Individual
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Provider Name | ROODI GHASSAN-TOBYA KATOOLA
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Gender | Male
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Dates
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Enumeration Date | 09/28/2022
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 5990 SASHABAW RD
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City | CLARKSTON
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State | MI
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Zip | 48346-3154
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Country | US
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Telephone | 248-736-1208
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Fax |
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Provider Business Mailing Address
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Address Line | 30704 HUNTSMAN DR E
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-1378
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Country | US
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Telephone | 248-736-1208
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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 | 5302414608
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License Number State | MI
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