Provider Demographics
NPI:1336355221
Name:SALEM, FADI FAROOK (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:FADI
Middle Name:FAROOK
Last Name:SALEM
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 SAXONY DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1089
Mailing Address - Country:US
Mailing Address - Phone:248-828-2931
Mailing Address - Fax:
Practice Address - Street 1:3986 JOHN R RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5688
Practice Address - Country:US
Practice Address - Phone:248-542-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist