Provider Demographics
NPI:1558466953
Name:SHUAYTO, HASSANE I (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:HASSANE
Middle Name:I
Last Name:SHUAYTO
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:MR
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:SHUAYTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15000 GRATIOT AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-1973
Mailing Address - Country:US
Mailing Address - Phone:313-521-7000
Mailing Address - Fax:313-245-1942
Practice Address - Street 1:15000 GRATIOT AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-1973
Practice Address - Country:US
Practice Address - Phone:313-521-7000
Practice Address - Fax:313-245-1942
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301006382183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2355469Medicaid