Provider Demographics
NPI:1962156539
Name:CHEAITO, ALI
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:CHEAITO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16347 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3360
Mailing Address - Country:US
Mailing Address - Phone:734-469-4657
Mailing Address - Fax:888-867-9794
Practice Address - Street 1:16347 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3360
Practice Address - Country:US
Practice Address - Phone:734-469-4657
Practice Address - Fax:888-867-9794
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039728183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302039728OtherPHARMACIST LICENSE