Provider Demographics
NPI:1629159744
Name:FAKHURI, TAREK A (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:A
Last Name:FAKHURI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2239
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N9B 3J7
Mailing Address - Country:CA
Mailing Address - Phone:313-647-9420
Mailing Address - Fax:
Practice Address - Street 1:16461 HARPER AVENUE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-2618
Practice Address - Country:US
Practice Address - Phone:313-647-9420
Practice Address - Fax:313-647-9426
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302033428OtherPHARMACIST LICENSE NUMBER