Provider Demographics
NPI:1821752254
Name:FANOUS, IHAB
Entity Type:Individual
Prefix:
First Name:IHAB
Middle Name:
Last Name:FANOUS
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 1:27 ANTIOCH CT
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-3704
Mailing Address - Country:US
Mailing Address - Phone:302-332-3128
Mailing Address - Fax:
Practice Address - Street 1:27 ANTIOCH CT
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-3704
Practice Address - Country:US
Practice Address - Phone:302-332-3128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0015731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1765704OtherDRIVER LICENCE