Provider Demographics
NPI:1760802714
Name:FATOHI, NIMAT
Entity Type:Individual
Prefix:DR
First Name:NIMAT
Middle Name:
Last Name:FATOHI
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 1:7700 N ALGER RD
Mailing Address - Street 2:WALMART PHARMACY 1422
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-9320
Mailing Address - Country:US
Mailing Address - Phone:989-463-3220
Mailing Address - Fax:
Practice Address - Street 1:7700 N ALGER RD
Practice Address - Street 2:WALMART PHARMACY 1422
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-9320
Practice Address - Country:US
Practice Address - Phone:989-463-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019531183500000X
MI5302039725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist