Basic Information
| Provider Information | |||||||||
| NPI: | 1346614518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KALASHO | ||||||||
| FirstName: | LINA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 S TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | BLOOMFIELD HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483020255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484091952 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2400 S TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | BLOOMFIELD HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483020255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484091952 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2015 | ||||||||
| LastUpdateDate: | 11/25/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 5302039052 | MI | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.