Provider Demographics
NPI:1154839827
Name:ABDULKAREEM, FARAH
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:ABDULKAREEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3165 E MICHIGAN AVE APT 123
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4633
Mailing Address - Country:US
Mailing Address - Phone:267-319-3066
Mailing Address - Fax:
Practice Address - Street 1:3700 W SAGINAW ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-2290
Practice Address - Country:US
Practice Address - Phone:517-321-7746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302046142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI183500000XOtherPHARMACIST