Healthcare Provider Details

I. General information

NPI: 1477711414
Provider Name (Legal Business Name): CHAWKI M FAKIH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 VENOY RD
WAYNE MI
48184-1869
US

IV. Provider business mailing address

4020 VENOY RD
WAYNE MI
48184-1869
US

V. Phone/Fax

Practice location:
  • Phone: 734-728-1591
  • Fax: 734-729-6546
Mailing address:
  • Phone: 734-728-1591
  • Fax: 734-729-6546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302028623
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: