Provider Demographics
NPI:1992249916
Name:SOUZAN TARRAF PLLC (DBA SOUTHFIELD SCRIPTS)
Entity type:Organization
Organization Name:SOUZAN TARRAF PLLC (DBA SOUTHFIELD SCRIPTS)
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SOUZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TARRAF
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:313-231-7262
Mailing Address - Street 1:17330 NORTHLAND PARK COURT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:248-621-9149
Mailing Address - Fax:248-621-9150
Practice Address - Street 1:17330 NORTHLAND PARK CT
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-621-9149
Practice Address - Fax:248-621-9150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010111173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166788OtherPK