Provider Demographics
NPI:1104463967
Name:ALFAKHOURY, LUNA F
Entity type:Individual
Prefix:
First Name:LUNA
Middle Name:F
Last Name:ALFAKHOURY
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 1:44478 BAYVIEW AVE APT 17211
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-7134
Mailing Address - Country:US
Mailing Address - Phone:586-846-7442
Mailing Address - Fax:
Practice Address - Street 1:16705 FORT ST
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1442
Practice Address - Country:US
Practice Address - Phone:734-286-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-28
Last Update Date:2019-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI191570806521835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist