Provider Demographics
NPI:1144048448
Name:ALDAHAN, YASSIN (PHARMD)
Entity type:Individual
Prefix:
First Name:YASSIN
Middle Name:
Last Name:ALDAHAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8304 RIVERDALE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1567
Mailing Address - Country:US
Mailing Address - Phone:313-858-5152
Mailing Address - Fax:
Practice Address - Street 1:22060 OUTER DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3932
Practice Address - Country:US
Practice Address - Phone:313-274-7651
Practice Address - Fax:313-274-7807
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302416520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist