Healthcare Provider Details

I. General information

NPI: 1548748767
Provider Name (Legal Business Name): VANNA FACHOU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 S ROCHESTER RD
ROCHESTER HILLS MI
48307-5042
US

IV. Provider business mailing address

14165 ELMHURST DR
STERLING HEIGHTS MI
48313-4371
US

V. Phone/Fax

Practice location:
  • Phone: 248-844-5010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302411686
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: