Provider Demographics
NPI:1215618228
Name:KASSIM, NOOR
Entity type:Individual
Prefix:
First Name:NOOR
Middle Name:
Last Name:KASSIM
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 1:2227 HICKORY RIDGE CT N
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2096
Mailing Address - Country:US
Mailing Address - Phone:267-456-7678
Mailing Address - Fax:
Practice Address - Street 1:2227 HICKORY RIDGE CT N
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2096
Practice Address - Country:US
Practice Address - Phone:267-456-7678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0013403183500000X
OH03440536183500000X
MAPH240119183500000X
MI5302041159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist