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NPI Code Detail

MEDICARE: DR. AMANDA FAWAZ PHARMD

MEDICARE:  DR. AMANDA  FAWAZ  PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist5302412012MI

General Provider Information

NPI Number : 1780234179
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMANDA FAWAZ PHARMD
Provider Business Mailing Address
First Line : 918 DAHLIA LN
Second Line :
City : ROCHESTER HILLS
State : MI
Zip : 48307-3306
Country : US
Telephone Number : 248-935-2452
Fax Number :
Provider Business Practice Location Address
First Line : 1026 N MAIN ST
Second Line :
City : ROYAL OAK
State : MI
Zip : 48067-1317
Country : US
Telephone Number : 248-546-4620
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2019
Last Update Date : 09/17/2019

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Directions to “ DR. AMANDA FAWAZ PHARMD” Practice Location

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