Provider Demographics
NPI:1407456692
Name:FANNING, BIANCA SADE' (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:SADE'
Last Name:FANNING
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:BIANCA
Other - Middle Name:SADE'
Other - Last Name:DONIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:5555 CONNER ST STE 2691
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-3812
Mailing Address - Country:US
Mailing Address - Phone:313-692-8405
Mailing Address - Fax:313-692-8426
Practice Address - Street 1:5555 CONNER ST STE 2691
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-3812
Practice Address - Country:US
Practice Address - Phone:313-692-8405
Practice Address - Fax:313-692-8426
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52430183500000X
MI5302046471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist