Provider Demographics
NPI:1912776667
Name:BANNO, FADI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FADI
Middle Name:
Last Name:BANNO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35412 OLD HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-2029
Mailing Address - Country:US
Mailing Address - Phone:248-795-8113
Mailing Address - Fax:
Practice Address - Street 1:31411 CHERRY HILL RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5264
Practice Address - Country:US
Practice Address - Phone:248-795-8113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302415776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist