Individual
LEILA FAWAZ
Active
Individual
LEILA FAWAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5302027842
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2995488
—
MI
Enumeration date
09/25/2015
Last updated
09/25/2015
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