Provider Demographics
NPI:1649992421
Name:HARAJLI, LAYLA
Entity type:Individual
Prefix:
First Name:LAYLA
Middle Name:
Last Name:HARAJLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26088 WILSON DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-4151
Mailing Address - Country:US
Mailing Address - Phone:313-333-3816
Mailing Address - Fax:
Practice Address - Street 1:17001 NEWBURGH RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1610
Practice Address - Country:US
Practice Address - Phone:734-462-1707
Practice Address - Fax:734-462-2427
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302414503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist