Provider Demographics
NPI:1952679268
Name:IROHA, FAUSTINA IFEOMA
Entity Type:Individual
Prefix:
First Name:FAUSTINA
Middle Name:IFEOMA
Last Name:IROHA
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 1:30917 WESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1466
Mailing Address - Country:US
Mailing Address - Phone:248-943-1123
Mailing Address - Fax:248-595-8299
Practice Address - Street 1:17653 12 MILE RD
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076
Practice Address - Country:US
Practice Address - Phone:248-943-1123
Practice Address - Fax:248-595-8299
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist