Provider Demographics
NPI:1699371104
Name:FAKHOURY, JOSEPH NURI
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:NURI
Last Name:FAKHOURY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 LAFAYETTE BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-2210
Mailing Address - Country:US
Mailing Address - Phone:313-354-5144
Mailing Address - Fax:313-871-0788
Practice Address - Street 1:6900 LAFAYETTE BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-2210
Practice Address - Country:US
Practice Address - Phone:313-354-5144
Practice Address - Fax:313-871-0788
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist