Provider Demographics
NPI:1477171189
Name:FARDOS, RIMA MOHAMMAD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RIMA
Middle Name:MOHAMMAD
Last Name:FARDOS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25486 CLAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3803
Mailing Address - Country:US
Mailing Address - Phone:120-141-4601
Mailing Address - Fax:
Practice Address - Street 1:25486 CLAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3803
Practice Address - Country:US
Practice Address - Phone:201-414-6013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302044844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist