Provider Demographics
NPI:1366001075
Name:FATIMA, TANVEER
Entity Type:Individual
Prefix:
First Name:TANVEER
Middle Name:
Last Name:FATIMA
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 1:27408 STRAWBERRY LN APT 102
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-5064
Mailing Address - Country:US
Mailing Address - Phone:248-880-2989
Mailing Address - Fax:
Practice Address - Street 1:10 S ORTONVILLE RD
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48462-8818
Practice Address - Country:US
Practice Address - Phone:248-627-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302040425OtherPHARMACIST LICENSE NUMBER