Provider Demographics
NPI:1215625140
Name:DAHER, ROUA (PHARMACIST)
Entity type:Individual
Prefix:
First Name:ROUA
Middle Name:
Last Name:DAHER
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 SADDLEBACK DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-3493
Mailing Address - Country:US
Mailing Address - Phone:616-591-4822
Mailing Address - Fax:
Practice Address - Street 1:315 SADDLEBACK DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-3493
Practice Address - Country:US
Practice Address - Phone:616-591-4822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302415084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist