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General NPI Number Information
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NPI Number | 1720746878
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Entity Type | Individual
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Provider Name | OMAR YEHIA FATTEH PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/06/2021
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 9300 JOSEPH CAMPAU ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3434
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Country | US
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Telephone | 313-874-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 2634 SALINA ST
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City | DEARBORN
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State | MI
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Zip | 48120-1598
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Country | US
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Telephone | 313-502-8297
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 5302413889
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License Number State | MI
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