Provider Demographics
NPI:1538605472
Name:ALASSAD, MULHAM (RPH)
Entity type:Individual
Prefix:
First Name:MULHAM
Middle Name:
Last Name:ALASSAD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 KIRTS BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4897
Mailing Address - Country:US
Mailing Address - Phone:855-362-3397
Mailing Address - Fax:
Practice Address - Street 1:830 KIRTS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4897
Practice Address - Country:US
Practice Address - Phone:855-362-3397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH237418183500000X
OKR-17258183500000X
TX59807183500000X
MI5302043241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist