Provider Demographics
NPI:1972398782
Name:FOUANI, KAOWTHER
Entity type:Individual
Prefix:
First Name:KAOWTHER
Middle Name:
Last Name:FOUANI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 S PINEVIEW PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-8637
Mailing Address - Country:US
Mailing Address - Phone:313-638-0893
Mailing Address - Fax:
Practice Address - Street 1:4100 E BROADWAY RD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-8843
Practice Address - Country:US
Practice Address - Phone:602-438-9301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302413789183500000X
AZS027324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist