Provider Demographics
NPI:1194807222
Name:FAKIH, HAYTHAM (RPH)
Entity type:Individual
Prefix:MR
First Name:HAYTHAM
Middle Name:
Last Name:FAKIH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5711 SCHAEFER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2252
Mailing Address - Country:US
Mailing Address - Phone:313-581-2424
Mailing Address - Fax:313-581-2193
Practice Address - Street 1:5711 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2252
Practice Address - Country:US
Practice Address - Phone:313-581-2424
Practice Address - Fax:313-581-2193
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301006444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist