Provider Demographics
NPI:1407465206
Name:KHALIFEH, FARAH
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:KHALIFEH
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 1:4886 MADDIE LN
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4173
Mailing Address - Country:US
Mailing Address - Phone:734-612-8886
Mailing Address - Fax:
Practice Address - Street 1:660 WOODWARD AVE STE 100RX
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-3516
Practice Address - Country:US
Practice Address - Phone:313-771-6039
Practice Address - Fax:313-771-6040
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302045142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist