Healthcare Provider Details

I. General information

NPI: 1003749524
Provider Name (Legal Business Name): MICHAEL FABER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 E DIVISION ST
FOND DU LAC WI
54935-4560
US

IV. Provider business mailing address

N117W17780 AUGUSTA CT
GERMANTOWN WI
53022-5644
US

V. Phone/Fax

Practice location:
  • Phone: 920-926-4664
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number16819-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: