1699875088 NPI number — FAKIH PHARMACY INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699875088 NPI number — FAKIH PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAKIH PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TRUDELL PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699875088
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5711 SCHAEFER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEARBORN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-581-2424
Provider Business Mailing Address Fax Number:
313-581-2193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5711 SCHAEFER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-581-2424
Provider Business Practice Location Address Fax Number:
313-581-2193
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FAKIH
Authorized Official First Name:
HAYTHAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
313-581-2424

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 540H20857 . This is a "BCBSM DME" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2307165 . This is a "NCPDP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 873263239 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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