Provider Demographics
NPI:1558498378
Name:GILLANDERS, FADWA FAITH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FADWA
Middle Name:FAITH
Last Name:GILLANDERS
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 1:606 ROYAL AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3223
Mailing Address - Country:US
Mailing Address - Phone:248-588-1291
Mailing Address - Fax:
Practice Address - Street 1:35244 DODGE PARK RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-3923
Practice Address - Country:US
Practice Address - Phone:248-790-1159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist