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NPI Code Detail

MEDICARE: FADWA SALEM RPH

MEDICARE: FADWA SALEM 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
1183500000XPharmacist5302033360MI

General Provider Information

NPI Number : 1942436944
Entity Type Code : Individual
Provider Name (Legal Business Name) : FADWA SALEM RPH
Provider Business Mailing Address
First Line : 5544 MADEIRA CT
Second Line :
City : STERLING HEIGHTS
State : MI
Zip : 48314-1305
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2003 E 12 MILE RD
Second Line :
City : WARREN
State : MI
Zip : 48092-5642
Country : US
Telephone Number : 586-751-3600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2009
Last Update Date : 06/03/2009

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