Provider Demographics
NPI:1629499371
Name:IKRAM, ROBINA FAROOQ (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ROBINA
Middle Name:FAROOQ
Last Name:IKRAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 EVELYN LN APT 202
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4050
Mailing Address - Country:US
Mailing Address - Phone:248-979-6433
Mailing Address - Fax:
Practice Address - Street 1:4400 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1222
Practice Address - Country:US
Practice Address - Phone:248-673-2107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-25
Last Update Date:2013-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037386183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist