Provider Demographics
NPI:1578914230
Name:TARAKJI, BRITTANY
Entity Type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:
Last Name:TARAKJI
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 1:1629 BOURNEMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1989
Mailing Address - Country:US
Mailing Address - Phone:304-993-3109
Mailing Address - Fax:
Practice Address - Street 1:107 KERCHEVAL AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-3618
Practice Address - Country:US
Practice Address - Phone:313-886-5655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist