Provider Demographics
NPI:1053145466
Name:SHAHIN, MARWA MOUSTAFA
Entity type:Individual
Prefix:
First Name:MARWA
Middle Name:MOUSTAFA
Last Name:SHAHIN
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 1:1783 CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1773
Mailing Address - Country:US
Mailing Address - Phone:734-576-0164
Mailing Address - Fax:
Practice Address - Street 1:3883 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8564
Practice Address - Country:US
Practice Address - Phone:517-552-6610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302416732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist