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General NPI Number Information
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NPI Number | 1952679268
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Entity Type | Individual
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Provider Name | FAUSTINA IFEOMA IROHA
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Gender | Female
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Dates
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Enumeration Date | 12/01/2011
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 17653 12 MILE RD
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076
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Country | US
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Telephone | 248-943-1123
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Fax | 248-595-8299
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Provider Business Mailing Address
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Address Line | 30917 WESTWOOD RD
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-1466
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Country | US
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Telephone | 248-943-1123
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Fax | 248-595-8299
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302027878
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License Number State | MI
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