Provider Demographics
NPI:1962735613
Name:CHEAITO-HAMIEH, SUHA
Entity type:Individual
Prefix:
First Name:SUHA
Middle Name:
Last Name:CHEAITO-HAMIEH
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 1:14657 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2483
Mailing Address - Country:US
Mailing Address - Phone:313-737-0804
Mailing Address - Fax:734-281-9201
Practice Address - Street 1:14657 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2483
Practice Address - Country:US
Practice Address - Phone:313-737-0804
Practice Address - Fax:734-281-9201
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist