Provider Demographics
NPI:1194600353
Name:RAFIQUE, SIDRAH (PHARMD)
Entity type:Individual
Prefix:
First Name:SIDRAH
Middle Name:
Last Name:RAFIQUE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-5443
Mailing Address - Country:US
Mailing Address - Phone:734-667-1764
Mailing Address - Fax:
Practice Address - Street 1:300 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-5443
Practice Address - Country:US
Practice Address - Phone:734-667-1764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist