Provider Demographics
NPI:1154943850
Name:CHEHAB, KASSEM (PHARMD)
Entity type:Individual
Prefix:
First Name:KASSEM
Middle Name:
Last Name:CHEHAB
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 1:2035 N HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1250
Mailing Address - Country:US
Mailing Address - Phone:313-622-3189
Mailing Address - Fax:
Practice Address - Street 1:1065 N HURON RIVER DR STE 600
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-3296
Practice Address - Country:US
Practice Address - Phone:734-547-5995
Practice Address - Fax:734-547-5974
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302046253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist