MEDICARE: DR. TAREK A FAKHURI PHARM D

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	5302033428	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5302033428	OTHER	MI	PHARMACIST LICENSE NUMBER

General Provider Information

NPI Number	:	1629159744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAREK A FAKHURI PHARM D

Provider Business Mailing Address
First Line	:	2239
Second Line	:
City	:	WINDSOR
State	:	ONTARIO
Zip	:	N9B 3J7
Country	:	CA
Telephone Number	:	313-647-9420
Fax Number	:

Provider Business Practice Location Address
First Line	:	16461 HARPER AVENUE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-2618
Country	:	US
Telephone Number	:	313-647-9420
Fax Number	:	313-647-9426

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	09/24/2008

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