Provider Demographics
NPI:1306676622
Name:FAKHRI, AMENA
Entity type:Individual
Prefix:
First Name:AMENA
Middle Name:
Last Name:FAKHRI
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 1:900 N WASHINGTON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-1258
Mailing Address - Country:US
Mailing Address - Phone:410-522-5639
Mailing Address - Fax:410-522-6153
Practice Address - Street 1:900 N WASHINGTON ST STE 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-1258
Practice Address - Country:US
Practice Address - Phone:410-522-5639
Practice Address - Fax:410-522-6153
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist