Provider Demographics
NPI:1831483775
Name:FAKIH, FARAH MAHMOUD
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:MAHMOUD
Last Name:FAKIH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26650 FORD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2841
Mailing Address - Country:US
Mailing Address - Phone:313-565-1287
Mailing Address - Fax:313-565-1287
Practice Address - Street 1:26650 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2841
Practice Address - Country:US
Practice Address - Phone:313-565-1287
Practice Address - Fax:313-565-1287
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist