MEDICARE: MRS. FATME RAKINE

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	5302029142	MI

General Provider Information

NPI Number	:	1215285960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FATME RAKINE

Provider Business Mailing Address
First Line	:	29452 CHERRY HILL RD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-2613
Country	:	US
Telephone Number	:	734-522-3332
Fax Number	:	734-522-3342

Provider Business Practice Location Address
First Line	:	29452 CHERRY HILL RD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-2613
Country	:	US
Telephone Number	:	734-522-3332
Fax Number	:	734-522-3342

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

Provider Enumeration Date	:	08/28/2012
Last Update Date	:	08/28/2012

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