Healthcare Provider Details

I. General information

NPI: 1346650140
Provider Name (Legal Business Name): JOY FAKHOURI PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49900 GRAND RIVER AVE
WIXOM MI
48393-3308
US

IV. Provider business mailing address

36537 GARDNER ST
LIVONIA MI
48152-2781
US

V. Phone/Fax

Practice location:
  • Phone: 248-449-8533
  • Fax: 248-449-8565
Mailing address:
  • Phone: 248-996-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302039401
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: