Provider Demographics
NPI:1730843764
Name:NASSER, SAEED DHAIFULLAH (PHARMD)
Entity type:Individual
Prefix:
First Name:SAEED
Middle Name:DHAIFULLAH
Last Name:NASSER
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 1:3016 AMAZON ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1429
Mailing Address - Country:US
Mailing Address - Phone:313-566-3858
Mailing Address - Fax:
Practice Address - Street 1:28675 HOOVER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-4105
Practice Address - Country:US
Practice Address - Phone:586-522-4334
Practice Address - Fax:586-920-2678
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302413844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist