Healthcare Provider Details

I. General information

NPI: 1629159744
Provider Name (Legal Business Name): TAREK A FAKHURI PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16461 HARPER AVENUE
DETROIT MI
48224-2618
US

IV. Provider business mailing address

2239
WINDSOR ONTARIO
N9B 3J7
CA

V. Phone/Fax

Practice location:
  • Phone: 313-647-9420
  • Fax: 313-647-9426
Mailing address:
  • Phone: 313-647-9420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302033428
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: