Provider Demographics
NPI:1124431192
Name:HASSAN, SYED
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:
Last Name:HASSAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5018 CLIO RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-1809
Mailing Address - Country:US
Mailing Address - Phone:810-787-2232
Mailing Address - Fax:
Practice Address - Street 1:5018 CLIO RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-1809
Practice Address - Country:US
Practice Address - Phone:810-787-2232
Practice Address - Fax:810-787-2716
Is Sole Proprietor?:No
Enumeration Date:2014-06-08
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist