Provider Demographics
NPI:1962100289
Name:ALKHATEEB, THAMER S (PHARMD)
Entity type:Individual
Prefix:
First Name:THAMER
Middle Name:S
Last Name:ALKHATEEB
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 1:12101 JOS CAMPAU ST APT 1
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-2590
Mailing Address - Country:US
Mailing Address - Phone:313-305-4746
Mailing Address - Fax:313-305-4759
Practice Address - Street 1:12101 JOS CAMPAU ST APT 1
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-2590
Practice Address - Country:US
Practice Address - Phone:313-305-4746
Practice Address - Fax:313-305-4759
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302415009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist