MEDICARE: MRS. SARA ALHAN FAKHOURY RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26115	MI

General Provider Information

NPI Number	:	1184867228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA ALHAN FAKHOURY RPH

Provider Business Mailing Address
First Line	:	2114 HAVERFORD DR
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48098-5331
Country	:	US
Telephone Number	:	248-952-5879
Fax Number	:

Provider Business Practice Location Address
First Line	:	1378 WALTON BLVD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1754
Country	:	US
Telephone Number	:	248-652-0900
Fax Number	:	248-652-2102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2009
Last Update Date	:	04/17/2009

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