Provider Demographics
NPI:1174261630
Name:FAKIH, ALI J
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:J
Last Name:FAKIH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 DACOSTA ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1428
Mailing Address - Country:US
Mailing Address - Phone:313-477-3005
Mailing Address - Fax:
Practice Address - Street 1:24401 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-1616
Practice Address - Country:US
Practice Address - Phone:313-532-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028259183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist